Dataset Information

Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.

ABSTRACT: 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.

SUBMITTER: Meza E

PROVIDER: S-EPMC7745730 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Publications

Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.

Meza Erika E Eng Chloe W CW Sáenz Joseph L JL Gilsanz Paola P Glymour Medellena Maria MM Torres Jacqueline M JM

Journal of the American Geriatrics Society 20200902 11

<h4>Background/objectives</h4>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.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>The Mexican Health and Aging Study is a national population-based study of older adults in Mexico.<h4>Participants</h4>A total ...[more]

PMID: 32880905

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Project description:Depression has been identified as a risk factor for dementia. However, most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time.To investigate the association between trajectories of depressive symptoms and risk of dementia in older adults.This was a prospective cohort investigation of black and white community-dwelling older adults in the Health, Aging, and Body Composition study. Participants were enrolled between May 1997 and June 1998 and followed up through 2001-2002. The dates of this analysis were September 2014 to December 2015. The setting was community research centers in Memphis, Tennessee, and Pittsburgh, Pennsylvania. Trajectories of depressive symptoms were assessed from baseline to year 5. Symptoms were measured with the Center for Epidemiologic Studies Depression Scale Short Form, and trajectories were calculated using latent class growth curve analysis.Incident dementia through year 11, determined by dementia medication use, hospital records, or significant cognitive decline (?1.5 SD race-specific decline on the Modified Mini-Mental State Examination). We examined the association between depressive symptom trajectories and dementia incidence using Cox proportional hazards regression models adjusted for demographics, health factors that differed between groups, and cognition during the depressive symptom assessment period (baseline to year 5).The analytic cohort included 2488 black and white older adults with repeated depressive symptom assessments from baseline to year 5 who were free of dementia throughout that period. Their mean (SD) age at baseline was 74.0 (2.8) years, and 53.1% (n?=?1322) were female. The following 3 depressive symptom trajectories were identified: consistently minimal symptoms (62.0% [n?=?1542] of participants), moderate and increasing symptoms (32.2% [n?=?801] of participants), and high and increasing symptoms (5.8% [n?=?145] of participants). Compared with the consistently minimal trajectory, having a high and increasing depressive symptom trajectory was associated with significantly increased risk of dementia (fully adjusted hazard ratio, 1.94; 95% CI, 1.30-2.90), while the moderate and increasing trajectory was not associated with risk of dementia after full adjustment. Sensitivity analyses indicated that the high and increasing trajectory was associated with dementia incidence, while depressive symptoms at individual time points were not.Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals' trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.

Dataset Information

Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.

Publications

Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.

Similar Datasets

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