title: Associations between DSM-IV mental disorders and subsequent non-fatal, self-reported stroke.
abstract: OBJECTIVE
  To examine the associations between a wide range of mental disorders and subsequent onset of stroke. Lifecourse timing of stroke was examined using retrospectively reconstructed data from cross-sectional surveys.
  
  
  METHODS
  Data from the World Mental Health Surveys were accessed. This data was collected from general population surveys over 17 countries of 87,250 adults. The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of DSM-IV mental disorders. A weighted subsample (n=45,288), was used for analysis in the present study. Survival analyses estimated associations between first onset of mental disorders and subsequent stroke onset.
  
  
  RESULTS
  Bivariate models showed that 12/16 mental disorders were associated with subsequent stroke onset (ORs ranging from 1.6 to 3.8). However, after adjustment for mental disorder comorbidity and smoking, only significant relationships between depression and stroke (OR 1.3) and alcohol abuse and stroke (OR 1.5) remained. Among females, having a bipolar disorder was also associated with increased stroke incidence (OR 2.1). Increasing number of mental disorders was associated with stroke onset in a dose-response fashion (OR 3.3 for 5+ disorders).
  
  
  CONCLUSIONS
  Depression and alcohol abuse may have specific associations with incidence of non-fatal stroke. General severity of psychopathology may be a more important predictor of non-fatal stroke onset. Mental health treatment should be considered as part of stroke risk prevention. Limitations of retrospectively gathered cross sectional surveys design mean further research on the links between mental health and stroke incidence is warranted.
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand. Electronic address: Nicola.swain@otago.ac.nz.
authors.forename: Nicola R
authors.initials: NR
authors.lastname: Swain
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Carmen C W
authors.initials: CC
authors.lastname: Lim
authors.affiliation: Ministry of Health Israel, Mental Health Services, Israel.
authors.forename: Daphna
authors.initials: D
authors.lastname: Levinson
authors.affiliation: Unit of Analysis and Generation of Evidence for Public Health, Peruvian National Institute of Health, Peru.
authors.forename: Fabian
authors.initials: F
authors.lastname: Fiestas
authors.affiliation: IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Institute of Psychiatry and Neurology, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Moskalewicz
authors.affiliation: Assistance Publique Hôpitaux de Paris, Universités Paris Descartes - Paris Diderot Inserm UMR-S 1144, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lepine
authors.affiliation: Colegio Mayor de Cundinamarca University, Columbia.
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: National Institute of Psychiatry Ramon de la Fuente, Mexico.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: Chronic Diseases Research Center (CEDOC), Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Xavier
authors.affiliation: Department of Clinical Psychology, Hiroshima International University, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Iwata
authors.affiliation: University of Groningen, University Medical Center, Groningen Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Belgium.
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.affiliation: School of Psychology, University of Ulster, Northern Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, United States.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D016019:Survival Analysis; D055815:Young Adult
keywords: Alcohol abuse; Comorbidity; Depression; Stroke