Stroke: depression increased the risk of stroke mortality.

Clinical bottom line (level 1b)

  1. A fortieth of the adult population suffered stroke mortality.
  2. Patients were at increased risk of stroke mortality if they reported 5 or more depressive symptoms.
Everson et al: Archives of Internal Medicine 1998; 158: 1133-1138
Expires November 2002

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: community-based, USA

6676 patients (aged range 17 to 94 years; mean 44, 54% female) stroke-free

Excluded if
  • incomplete or missing data on the depression scale
  • missing data on covariates




    • Cox proportional hazards models were used to adjust for confounding factors.

    100% followed for 29 years
    Outcomes studied:
  • stroke mortality

    • 79% of patients were white.
    • No data for non-fatal strokes

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    stroke mortality 29 years 169/6676 2.53%
    (2.16% to 2.91%)

    prognostic factor for
    stroke mortality     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    reporting 5 or more depressive symptoms 29 years 5707/6676
    (85.5%)     		1.54
    (1.06 to 2.22)     		22
    (14 to 141)

    • Score of five or more on the Human Population Laboratory Depression Scale is considered indicative of depression or mood disturbance (not necessarily clinical depression).
    • Odds ratio adjusted for age, sex, race, education, alcohol consumption, smoking, body mass index, hypertension and diabetes.

    Citation

    1. Everson SA, Roberts RE, Goldberg DE, et al: Depressive symptoms and increased risk of stroke mortality over a 29-year period. Archives of Internal Medicine 1998; 158: 1133-1138
    Contributor: Clare Wotton; Lee Bailey, November 1999
    Reviewer: Guido Pieters

    Clinical Question.
    Patient stroke-free
    Intervention or Exposure depressive symptoms
    Comparison no depressive symptoms
    Outcome stroke mortality