PT  - JOURNAL ARTICLE
AU  - Cassandra D. Ford
AU  - Marquita S. Gray
AU  - Martha R. Crowther
AU  - Virginia G. Wadley
AU  - Audrey L. Austin
AU  - Michael G. Crowe
AU  - LeaVonne Pulley
AU  - Frederick Unverzagt
AU  - Dawn O. Kleindorfer
AU  - Brett M. Kissela
AU  - Virginia J. Howard
TI  - Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS
AID  - 10.1212/CPJ.0000000000000983
DP  - 2021 Aug 01
TA  - Neurology: Clinical Practice
PG  - e454--e461
VI  - 11
IP  - 4
4099  - http://cp.neurology.org/content/11/4/e454.short
4100  - http://cp.neurology.org/content/11/4/e454.full
AB  - Objective The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants.Methods The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003–2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1–3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors.Results There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1–3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23–1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11–1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27–1.85), with risk attenuated in the full model similar to risk with 1–3 symptoms (HR = 1.25, 95% CI = 1.03–1.51). There was no evidence of a differential effect by race (p = 0.53).Conclusions The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.