title: Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis.
abstract: BACKGROUND
  Several studies suggest that perceived psychosocial stress is associated with increased risk of stroke; however results are inconsistent with regard to definitions and measurement of perceived stress, features of individual study design, study conduct and conclusions drawn and no meta-analysis has yet been published. We performed a systematic review and meta-analysis of studies assessing association between perceived psychosocial stress and risk of stroke in adults.The results of the meta-analysis are presented.
  
  
  METHODS
  Systematic searches of MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews were undertaken between 1980 and June 2014. Data extraction and quality appraisal was performed by two independent reviewers. Hazard ratios (HR) and odds ratios (OR) were pooled where appropriate.
  
  
  RESULTS
  14 studies were included in the meta-analysis, 10 prospective cohort, 4 case-control design. Overall pooled adjusted effect estimate for risk of total stroke in subjects exposed to general or work stress or to stressful life events was 1.33 (95 % confidence interval [CI], 1.17, 1.50; P < 0.00001). Sub-group analyses showed perceived psychosocial stress to be associated with increased risk of fatal stroke (HR 1.45 95 % CI, 1.19,1.78; P = 0.0002), total ischaemic stroke (HR 1.40 95 % CI, 1.00,1.97; P = 0.05) and total haemorrhagic stroke (HR 1.73 95 % CI, 1.33,2.25; P > 0.0001).A sex difference was noted with higher stroke risk identified for women (HR 1.90 95 % CI, 1.4, 2.56: P < 0.0001) compared to men (HR 1.24 95 % CI, 1.12, 1.36; P < 0.0001).
  
  
  CONCLUSIONS
  Current evidence indicates that perceived psychosocial stress is independently associated with increased risk of stroke.
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK. jo.booth@gcu.ac.uk.
authors.forename: Joanne
authors.initials: J
authors.lastname: Booth
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK. Lesley.connelly@gcu.ac.uk.
authors.forename: Lesley
authors.initials: L
authors.lastname: Connelly
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK. Maggie.lawrence@gcu.ac.uk.
authors.forename: Maggie
authors.initials: M
authors.lastname: Lawrence
authors.affiliation: NHS Lanarkshire, Coathill Hospital, Hospital Street, Coatbridge, ML5 4DN, UK. Campbell.chalmers@lanarkshire.scot.nhs.uk.
authors.forename: Campbell
authors.initials: C
authors.lastname: Chalmers
authors.affiliation: School of Psychology, Massey University, Private Bag 11 222, Palmerston North, New Zealand. S.A.Joice@massey.ac.nz.
authors.forename: Sara
authors.initials: S
authors.lastname: Joice
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK. Clarissa.becker@gmail.com.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Becker
authors.affiliation: Nursing, Midwifery & Allied Health Professions Research Unit, University of Stirling Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK. Nadine.dougall@stir.ac.uk.
authors.forename: Nadine
authors.initials: N
authors.lastname: Dougall
mesh_terms: D002545:Brain Ischemia / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications*; D020521:Stroke / Q000209:etiology*