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Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population
Author(s) -
Meza Erika,
Eng Chloe W.,
Sáenz Joseph L.,
Gilsanz Paola,
Glymour Medellena Maria,
Torres Jacqueline M.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16718
Subject(s) - medicine , stroke (engine) , depressive symptoms , gerontology , population , depression (economics) , psychiatry , environmental health , cognition , mechanical engineering , engineering , economics , macroeconomics
BACKGROUND/OBJECTIVES Several longitudinal studies in high‐income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low‐ and middle‐income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. DESIGN Prospective cohort study. SETTING The Mexican Health and Aging Study is a national population‐based study of older adults in Mexico. PARTICIPANTS A total of 10,693 Mexican adults aged 50 and older enrolled in 2001 with no history of prior stroke. MEASUREMENTS Depressive symptoms were assessed with a modified 9‐item Centers for Epidemiologic Studies Depression Scale (elevated depressive symptom cutoff ≥5) in 2001 and 2003. We evaluated associations between baseline and short‐term (2‐year) changes in elevated depressive symptoms (categorized as stable low, recently remitted, recent‐onset, or stable high symptoms) with incident self‐reported or next‐of‐kin reported doctor‐diagnosed stroke through 2015 using Cox proportional hazards models and sensitivity analyses applying inverse probability weights. RESULTS Over an average follow‐up of 11.4 years (standard deviation = 4.2), 10,693 respondents reported 546 incident strokes. Individuals with elevated baseline depressive symptoms experienced a moderately higher hazard of incident stroke (hazard ratio [HR] = 1.13; 95% confidence interval [CI] = .95–1.36) compared with those without elevated baseline depressive symptoms. In analyses of short‐term changes in elevated depressive symptoms (n = 8,808; 414 incident stokes), participants with recent‐onset (HR = 1.38; 95% CI = 1.06–1.81) or stable high (HR = 1.42; 95% CI = 1.10–1.84) elevated depressive symptoms had a greater hazard of incident stroke compared to those with stable low/no depressive symptoms, whereas recently remitted (HR = 1.01; 95% CI = .74–1.37) symptoms was not associated with stroke hazard. CONCLUSION Strategies to reduce depressive symptoms merit evaluation as approaches to prevent stroke in middle‐income countries. Findings are similar to those in high‐income countries but should be replicated in other LMICs.