title: Changes in Depressive Symptoms and Subsequent Risk of Stroke in the Cardiovascular Health Study.
abstract: Depression is associated with stroke, but the effects of changes in depressive symptoms on stroke risk are not well understood. This study examined whether depressive symptom changes across 2 successive annual assessments were associated with incident stroke the following year.
  
  
  
  We used visit data from 4319 participants of the Cardiovascular Health Study who were stroke free at baseline to examine whether changes in depressive symptoms classified across 2 consecutive annual assessments predicted incident first stroke during the subsequent year. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression scale (high versus low at ≥10). Survival models were inverse probability weighted to adjust for demographics, health behaviors, medical conditions, past depressive symptoms, censoring, and survival.
  
  
  
  During follow-up, 334 strokes occurred. Relative to stable low scores of depressive symptoms, improved depression symptoms were associated with almost no excess risk of stroke (adjusted hazards ratio, 1.02; 95% confidence interval, 0.66-1.58). New-onset symptoms were nonsignificantly associated with elevated stroke risk (adjusted hazards ratio, 1.44; 95% confidence interval, 0.97-2.14), whereas persistently high depressive symptoms were associated with elevated adjusted hazard of all-cause stroke (adjusted hazards ratio, 1.65; 95% confidence interval, 1.06-2.56). No evidence for effect modification by race, age, or sex was found.
  
  
  
  Persistently high symptoms of depression predicted elevated hazard of stroke. Participants with improved depressive symptoms had no elevation in stroke risk. Such findings suggest that strategies to reduce depressive symptoms may ameliorate stroke risk.
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.). pgilsanz@mail.harvard.edu.
authors.forename: Paola
authors.initials: P
authors.lastname: Gilsanz
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Tchetgen Tchetgen
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Qianyi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Patton
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Annette L
authors.initials: AL
authors.lastname: Fitzpatrick
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Kop
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.affiliation: From the Department of Social and Behavioral Sciences (P.G., L.D.K., I.K., M.M.G.), Department of Biostatistics (E.J.T.T.), and Department of Epidemiology (E.J.T.T., Q.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Division of Cardiology (K.K.P.), Department Epidemiology (A.L.F., W.T.L.), Department of Family Medicine (A.L.F.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands (W.J.K.); and Department of Epidemiology and Biostatistics, University of California, San Francisco (M.M.G.).
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology
keywords: depression; epidemiology; probability; risk; stroke