Depression, Stress, Hostility Ups Stroke Risk

Middle-aged adults experiencing high stress, hostility and depression are at a significantly higher risk of stroke or transient ischemic attack.

Transient Ishemic Attack (TIA) is also called a mini stroke and is considered as a warning stroke. It occurs when the flow of blood to a part of the brain stops for a brief period of time due to presence of a clot. The difference between stroke and TIA is that the blockage is temporary in the latter.

In this study, researchers evaluated how psychological factors influenced the risk for chronic disease, using data retrieved from an ongoing study on the risk factors of cardiovascular diseases among those residing in six U.S. cities.

The study included over 6,700 adults aged between 45-84 years, in which 53 percent of the women were made to complete a questionnaire on chronic stress, depression, anger and hostility over two years. The participants included 38.5 percent of white, 27.8 percent African-American, 21.9 percent Hispanic and 11.8 percent Chinese people. None of these participants had a history of cardiovascular diseases at the beginning of the study. During the 8.5 to 11 years of follow up, 147 strokes and 48 TIAs were reported.

When compared to those with lowest psychological score, those with highest scores were 86 percent more vulnerable to suffer a stroke or TIA if they were depressed, 59 percent more likely to have a stroke if they experienced chronic stress, in case of hostility there was a two-fold increased risk and no significant higher risk in case of anger.

"There's such a focus on traditional risk factors - cholesterol levels, blood pressure, smoking and so forth - and those are all very important, but studies like this one show that psychological characteristics are equally important," said lead author Susan Everson-Rose, Ph.D., M.P.H. "Given our aging population, it's important to consider these other factors that might play a role in disease risk. Stroke is a disease of the elderly predominantly, and so learning more about things that can influence risk for stroke as people age is important."

The researchers measured the chronic stress of participants using five factors: personal health problem, health problems of people close to them, job or ability to work, relationships and finances. They used a 20-question scale to measure depression and a 10-item scale to measure anger. They tracked hostility, by assessing the person's cynical expectations of the motives of others.

"One thing we didn't assess is coping strategies," Everson-Rose said. "If someone is experiencing depressive symptoms or feeling a lot of stress or hostility, we don't know how they manage those, so it's possible that positive coping strategies could ameliorate some of these associations or effects."

The study appeared in the American Heart Association journal Stroke.