Depression Is Associated with a Higher Risk of Death among Stroke Survivors

Ali Razmara; Natalie Valle; Daniela Markovic; Nerses Sanossian; Bruce Ovbiagele; Tara Dutta; Amytis Towfighi

doi:10.1016/j.jstrokecerebrovasdis.2017.07.006

Depression Is Associated with a Higher Risk of Death among Stroke Survivors

J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2870-2879. doi: 10.1016/j.jstrokecerebrovasdis.2017.07.006. Epub 2017 Aug 2.

Authors

Ali Razmara¹, Natalie Valle², Daniela Markovic³, Nerses Sanossian⁴, Bruce Ovbiagele⁵, Tara Dutta⁶, Amytis Towfighi⁷

Affiliations

¹ Department of Neurology, Kaiser Permanente, Irvine, California. Electronic address: alirazmara@outlook.com.
² Research Department, St. Jude Medical Center, Fullerton, California.
³ Department of Biomathematics, University of California Los Angeles, Los Angeles, California.
⁴ Department of Neurology, University of Southern California, Los Angeles, California.
⁵ Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
⁶ Department of Neurology, Kaiser Permanente, Sacramento, California.
⁷ Department of Neurology, University of Southern California, Los Angeles, California; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California.

PMID: 28780250
DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.006

Abstract

Background: Poststroke depression is common, affecting approximately 1 in 3 stroke survivors. We aimed to evaluate the association between depression and mortality in adults with and without prior stroke.

Methods: Using the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (1982-1992), we investigated the association between depression and all-cause mortality among adults aged 25-74 years with and without prior stroke, and stroke mortality among stroke survivors, adjusting for covariates.

Results: Among 9919 individuals, 121 (1.2%) reported prior stroke. The adjusted depression prevalence was 37.1% among stroke survivors and 17.3% among individuals without stroke. In persons aged 25-64 years, neither stroke nor depression was associated with all-cause mortality. The combination of depression and stroke was not associated with all-cause mortality (adjusted hazard ratio [HR] 2.83, 95% confidence interval [CI] .67-12.04). Among persons aged 65-74 years, depression alone (adjusted HR 1.24, 95% CI 1.04-1.47), stroke alone (adjusted HR 1.64, 95% CI 1.17-2.32), and the combination of depression and stroke (adjusted HR 2.28, 95% CI 1.79-2.90) were associated with all-cause mortality, consistent with an additive relationship. Among all ages, the combination of depression and stroke was associated with all-cause mortality (adjusted HR 1.93, 95% CI 1.28-2.92). Higher stroke mortality was only observed in those aged 65-74 years (adjusted HR 2.43, 95% CI 1.05-5.60). Compared with stroke survivors without depression, those with depression were ~35 times more likely to die from a stroke (adjusted HR 35.33, 95% CI 7.79-160.32).

Conclusions: The combination of prior stroke and depression is associated with higher all-cause mortality than either condition alone. The presence of depression after stroke increases stroke mortality 35-fold, highlighting the importance of identifying and treating depression among stroke survivors.

Keywords: Depression; death; mortality; outcome; stroke; stroke mortality.

MeSH terms

Adult
Affect*
Aged
Depression / diagnosis
Depression / mortality*
Depression / psychology
Female
Humans
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Nutrition Surveys
Odds Ratio
Prevalence
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Stroke / diagnosis
Stroke / mortality*
Stroke / psychology
Survivors / psychology*
Time Factors
United States / epidemiology