Comparing Variability, Severity, and Persistence of Depressive Symptoms as Predictors of Future Stroke Risk.
Am J Geriatr Psychiatry
; 25(2): 120-128, 2017 Feb.
Article
en En
| MEDLINE
| ID: mdl-27866734
ABSTRACT
OBJECTIVE:
Numerous studies show that depressive symptoms measured at a single assessment predict greater future stroke risk. Longer-term symptom patterns, such as variability across repeated measures or worst symptom level, might better reflect adverse aspects of depression than a single measurement. This prospective study compared five approaches to operationalizing depressive symptoms at annual assessments as predictors of stroke incidence.DESIGN:
Cohort followed for incident stroke over an average of 6.4 years.SETTING:
The Adult Changes in Thought cohort follows initially cognitively intact, community- dwelling older adults from a population base defined by membership in Group Health, a Seattle-based nonprofit healthcare organization.PARTICIPANTS:
3,524 individuals aged 65 years and older. MEASUREMENTS We identified 665 incident strokes using ICD codes. We considered both baseline Center for Epidemiologic Studies-Depression scale (CES-D) score and, using a moving window of three most recent annual CES-D measurements, we compared most recent, maximum, average, and intra-individual variability of CES-D scores as predictors of subsequent stroke using Cox proportional hazards models.RESULTS:
Greater maximum (hazard ratio [HR] 1.18; 95% CI 1.07-1.30), average (HR 1.20; 95% CI 1.05-1.36) and intra-individual variability (HR 1.15; 95% CI 1.06-1.24) in CES-D were each associated with elevated stroke risk, independent of sociodemographics, cardiovascular risks, cognition, and daily functioning. Neither baseline nor most recent CES-D was associated with stroke. In a combined model, intra-individual variability in CES-D predicted stroke, but average CES-D did not.CONCLUSIONS:
Capturing the dynamic nature of depression is relevant in assessing stroke risk. Fluctuating depressive symptoms may reflect a prodrome of reduced cerebrovascular integrity.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Accidente Cerebrovascular
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Depresión
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
País como asunto:
America do norte
Idioma:
En
Año:
2017
Tipo del documento:
Article