Download PDF
Semin Neurol 2017; 37(03): 294-306
DOI: 10.1055/s-0037-1603758
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Systematic Review and Meta-Analysis of Psychosocial Risk Factors for Stroke

C. Elizabeth Lightbody
1   School of Nursing, University of Central Lancashire, Brook Building, Preston, United Kingdom
,
Andrew Clegg
2   School of Health Sciences, University of Central Lancashire, Brook Building, Preston, United Kingdom
,
Kulsum Patel
3   School of Nursing, University of Central Lancashire, Brook Building, Preston, United Kingdom
,
Julie Cook Lucas
4   Research Support Team, Faculty of Health and Wellbeing, University of Central Lancashire, Brook Building, Preston, United Kingdom
,
Hannah Storey
4   Research Support Team, Faculty of Health and Wellbeing, University of Central Lancashire, Brook Building, Preston, United Kingdom
,
Maree L. Hackett
5   School of Nursing, University of Central Lancashire, Brook Building, Preston, United Kingdom
6   Neurological and Mental Health Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
,
Dame Caroline L. Watkins
7   Faculty of Health and Wellbeing, University of Central Lancashire, Brook Building, Preston, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
31 July 2017 (online)

    Permissions and Reprints

Abstract

Several studies have assessed the link between psychosocial risk factors and stroke; however, the results were inconsistent. We have conducted a systemic review and meta-analysis of cohort or case-control studies to ascertain the association between psychosocial risk factors (psychological, vocational, behavioral, interpersonal, and neuropsychological) and the risk of stroke. Systematic searches were undertaken in MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews between 2000 and January 2017. Two reviewers independently screened titles, abstracts, and full texts. One reviewer assessed quality and extracted data, which was checked by a second reviewer. For studies that reported risk estimates, a meta-analysis was performed. We identified 41 cohort studies and 5 case-control studies. No neuropsychological papers were found. Overall, pooled adjusted estimates showed that all other psychosocial risk factors were independent risk factors for stroke. Psychological factors increased the risk of stroke by 39% (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.27–1.51), vocational by 35% (HR, 1.35; 95% CI, 1.20–1.51), and interpersonal by 16% (HR, 1.16; 95% CI, 1.03–1.31), and the effects of behavioral factors were equivocal (HR, 0.94; 95% CI, 0.20–4.31). The meta-analyses were affected by heterogeneity. Psychosocial risk factors are associated with an increased risk of stroke.

Keywords

stroke - psychosocial - risk factor

Contribution of the Author

CEL, CW, KP, MLH, and AC conceived the concept of the study and contributed to the design of the study. AC, CEL, JCL, KP, and HS screened the studies; CEL, JCL, KP, HS, AC and MLH data extracted the literature. AC performed the data analysis, CEL, AC, and KP drafted the manuscript and all authors undertook a critical read and approved the final manuscript.


 

  • References

  • 1 World Health Organisation. The top 10 causes of death worldwide. 2017. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/ . Accessed March 1, 2017
    PubMedGoogle Scholar
  • 2 Neylon A, Canniffe C, Anand S. , et al. A global perspective on psychosocial risk factors for cardiovascular disease. Prog Cardiovasc Dis 2013; 55 (06) 574-581
    CrossrefPubMedGoogle Scholar
  • 3 Booth J, Connelly L, Lawrence M. , et al. Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis. BMC Neurol 2015; 15: 233
    CrossrefPubMedGoogle Scholar
  • 4 Dong JY, Zhang YH, Tong J, Qin LQ. Depression and risk of stroke: a meta-analysis of prospective studies. Stroke 2012; 43 (01) 32-37
    CrossrefPubMedGoogle Scholar
  • 5 Ligthart SA, Richard E, Fransen NL. , et al. Association of vascular factors with apathy in community-dwelling elderly individuals. Arch Gen Psychiatry 2012; 69 (06) 636-642
    PubMedGoogle Scholar
  • 6 Feller S, Teucher B, Kaaks R, Boeing H, Vigl M. Life satisfaction and risk of chronic diseases in the European prospective investigation into cancer and nutrition (EPIC)-Germany study. PLoS One 2013; 8 (08) e73462
    CrossrefPubMedGoogle Scholar
  • 7 Salinas J, Beiser A, Himali JJ. , et al. Associations between social relationship measures, serum brain-derived neurotrophic factor, and risk of stroke and dementia. Alzheimer's & Dementia. Translational Research & Clinical Interventions 2017; 3 (02) 229-237
    PubMedGoogle Scholar
  • 8 Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99 (16) 2192-2217
    CrossrefPubMedGoogle Scholar
  • 9 National Institute of Health. Study quality assessment tools. 2014. Available at: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools . Accessed November 1, 2016
    PubMed
  • 10 Higgins JPT, Green S. , Eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 . Available at: www.handbook.cochrane.org . Accessed August 3, 2016
    PubMedGoogle Scholar
  • 11 Lahti M, Tiihonen J, Wildgust H. , et al. Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia. Psychol Med 2012; 42 (11) 2275-2285
    CrossrefPubMedGoogle Scholar
  • 12 Salaycik KJ, Kelly-Hayes M, Beiser A. , et al. Depressive symptoms and risk of stroke: the Framingham Study. Stroke 2007; 38 (01) 16-21
    CrossrefPubMedGoogle Scholar
  • 13 André-Petersson L, Engström G, Hedblad B, Janzon L, Rosvall M. Social support at work and the risk of myocardial infarction and stroke in women and men. Soc Sci Med 2007; 64 (04) 830-841
    CrossrefPubMedGoogle Scholar
  • 14 Arbelaez JJ, Ariyo AA, Crum RM, Fried LP, Ford DE. Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study. J Am Geriatr Soc 2007; 55 (11) 1825-1830
    CrossrefPubMedGoogle Scholar
  • 15 Bos MJ, Lindén T, Koudstaal PJ. , et al. Depressive symptoms and risk of stroke: the Rotterdam Study. J Neurol Neurosurg Psychiatry 2008; 79 (09) 997-1001
    CrossrefPubMedGoogle Scholar
  • 16 Curkendall SM, Mo J, Glasser DB, Rose Stang M, Jones JK. Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry 2004; 65 (05) 715-720
    CrossrefPubMedGoogle Scholar
  • 17 Eurelings LSM, Ligthart SA, van Dalen JW, Moll van Charante EP, van Gool WA, Richard E. Apathy is an independent risk factor for incident cardiovascular disease in the older individual: a population-based cohort study. Int J Geriatr Psychiatry 2014; 29 (05) 454-463
    CrossrefPubMedGoogle Scholar
  • 18 Everson-Rose SA, Roetker NS, Lutsey PL. , et al. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke 2014; 45 (08) 2318-2323
    CrossrefPubMedGoogle Scholar
  • 19 Gillum RF, Mussolino ME. Education, poverty, and stroke incidence in whites and blacks: the NHANES I Epidemiologic Follow-up Study. J Clin Epidemiol 2003; 56 (02) 188-195
    CrossrefPubMedGoogle Scholar
  • 20 Hamano T, Li X, Lönn SL. , et al. Depression, stroke and gender: evidence of a stronger association in men. J Neurol Neurosurg Psychiatry 2015; 86 (03) 319-323
    CrossrefPubMedGoogle Scholar
  • 21 Honjo K, Iso H, Nakaya T. , et al; Japan Public Health Center-based Prospective Study Group. Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan. J Epidemiol 2015; 25 (03) 254-260
    CrossrefPubMedGoogle Scholar
  • 22 Ikeda A, Iso H, Kawachi I, Yamagishi K, Inoue M, Tsugane S. ; JPHC Study Group. Social support and stroke and coronary heart disease: the JPHC study cohorts II. Stroke 2008; 39 (03) 768-775
    CrossrefPubMedGoogle Scholar
  • 23 Kornerup H, Osler M, Boysen G, Barefoot J, Schnohr P, Prescott E. Major life events increase the risk of stroke but not of myocardial infarction: results from the Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil 2010; 17 (01) 113-118
    CrossrefPubMedGoogle Scholar
  • 24 Lee H-C, Lin H-C, Tsai S-Y. Severely depressed young patients have over five times increased risk for stroke: a 5-year follow-up study. Biol Psychiatry 2008; 64 (10) 912-915
    CrossrefPubMedGoogle Scholar
  • 25 Li C, Hedblad B, Rosvall M, Buchwald F, Khan FA, Engström G. Stroke incidence, recurrence, and case-fatality in relation to socioeconomic position: a population-based study of middle-aged Swedish men and women. Stroke 2008; 39 (08) 2191-2196
    CrossrefPubMedGoogle Scholar
  • 26 Lin H-C, Tsai S-Y, Lee H-C. Increased risk of developing stroke among patients with bipolar disorder after an acute mood episode: a six-year follow-up study. J Affect Disord 2007; 100 (1-3): 49-54
    CrossrefPubMedGoogle Scholar
  • 27 McFadden E, Luben R, Wareham N, Bingham S, Khaw KT. Social class, risk factors, and stroke incidence in men and women: a prospective study in the European prospective investigation into cancer in Norfolk cohort. Stroke 2009; 40 (04) 1070-1077
    CrossrefPubMedGoogle Scholar
  • 28 Mejía-Lancheros C, Estruch R, Martínez-González MA. , et al; PREDIMED Study Investigators. Impact of psychosocial factors on cardiovascular morbimortality: a prospective cohort study. BMC Cardiovasc Disord 2014; 14: 135
    CrossrefPubMedGoogle Scholar
  • 29 Nabi H, Koskenvuo M, Singh-Manoux A. , et al. Low pessimism protects against stroke: the Health and Social Support (HeSSup) prospective cohort study. Stroke 2010; 41 (01) 187-190
    CrossrefPubMedGoogle Scholar
  • 30 Nagayoshi M, Everson-Rose SA, Iso H, Mosley Jr TH, Rose KM, Lutsey PL. Social network, social support, and risk of incident stroke: Atherosclerosis Risk in Communities study. Stroke 2014; 45 (10) 2868-2873
    CrossrefPubMedGoogle Scholar
  • 31 Nilsson FM, Kessing LV. Increased risk of developing stroke for patients with major affective disorder--a registry study. Eur Arch Psychiatry Clin Neurosci 2004; 254 (06) 387-391
    CrossrefPubMedGoogle Scholar
  • 32 Shirai K, Iso H, Ohira T. , et al; Japan Public Health Center-Based Study Group. Perceived level of life enjoyment and risks of cardiovascular disease incidence and mortality: the Japan public health center-based study. Circulation 2009; 120 (11) 956-963
    CrossrefPubMedGoogle Scholar
  • 33 Surtees PG, Wainwright NWJ, Luben RL, Wareham NJ, Bingham SA, Khaw K-T. Adaptation to social adversity is associated with stroke incidence: evidence from the EPIC-Norfolk prospective cohort study. Stroke 2007; 38 (05) 1447-1453
    CrossrefPubMedGoogle Scholar
  • 34 Surtees PG, Wainwright NWJ, Luben RN, Wareham NJ, Bingham SA, Khaw K-T. Psychological distress, major depressive disorder, and risk of stroke. Neurology 2008; 70 (10) 788-794
    CrossrefPubMedGoogle Scholar
  • 35 Truelsen T, Nielsen N, Boysen G, Grønbaek M. ; Copenhagen City Heart Study. Self-reported stress and risk of stroke: the Copenhagen City Heart Study. Stroke 2003; 34 (04) 856-862
    CrossrefPubMedGoogle Scholar
  • 36 Tsai K-Y, Lee C-C, Chou Y-M, Su C-Y, Chou FH-C. The incidence and relative risk of stroke in patients with schizophrenia: a five-year follow-up study. Schizophr Res 2012; 138 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 37 Tsutsumi A, Kayaba K, Ishikawa S. Impact of occupational stress on stroke across occupational classes and genders. Soc Sci Med 2011; 72 (10) 1652-1658
    CrossrefPubMedGoogle Scholar
  • 38 Veronesi G, Ferrario MM, Chambless LE. , et al. Gender differences in the association between education and the incidence of cardiovascular events in Northern Italy. Eur J Public Health 2011; 21 (06) 762-767
    CrossrefPubMedGoogle Scholar
  • 39 Yan T, Escarce JJ, Liang L-J. , et al. Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study. Age Ageing 2013; 42 (03) 391-397
    CrossrefPubMedGoogle Scholar
  • 40 Engström G, Khan FA, Zia E. , et al. Marital dissolution is followed by an increased incidence of stroke. Cerebrovasc Dis 2004; 18 (04) 318-324
    CrossrefPubMedGoogle Scholar
  • 41 O'Donnell MJ, Chin SL, Rangarajan S. , et al; INTERSTROKE investigators. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016; 388 (10046): 761-775
    CrossrefPubMedGoogle Scholar
  • 42 Bergh C, Udumyan R, Fall K, Nilsagård Y, Appelros P, Montgomery S. Stress resilience in male adolescents and subsequent stroke risk: cohort study. J Neurol Neurosurg Psychiatry 2014; 85 (12) 1331-1336
    CrossrefPubMedGoogle Scholar
  • 43 Eng PM, Fitzmaurice G, Kubzansky LD, Rimm EB, Kawachi I. Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosom Med 2003; 65 (01) 100-110
    CrossrefPubMedGoogle Scholar
  • 44 Honjo K, Iso H, Inoue M, Tsugane S. ; Japan Public Health Center-based Prospective Study Group. Education, social roles, and the risk of cardiovascular disease among middle-aged Japanese women: the JPHC Study Cohort I. Stroke 2008; 39 (10) 2886-2890
    CrossrefPubMedGoogle Scholar
  • 45 Kuper H, Adami H-O, Theorell T, Weiderpass E. The socioeconomic gradient in the incidence of stroke: a prospective study in middle-aged women in Sweden. Stroke 2007; 38 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 46 Majed B, Arveiler D, Bingham A. , et al; PRIME Study Group. Depressive symptoms, a time-dependent risk factor for coronary heart disease and stroke in middle-aged men: the PRIME Study. Stroke 2012; 43 (07) 1761-1767
    CrossrefPubMedGoogle Scholar
  • 47 May M, McCarron P, Stansfeld S. , et al. Does psychological distress predict the risk of ischemic stroke and transient ischemic attack? The Caerphilly Study. Stroke 2002; 33 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 48 Schiöler L, Söderberg M, Rosengren A, Järvholm B, Torén K. Psychosocial work environment and risk of ischemic stroke and coronary heart disease: a prospective longitudinal study of 75 236 construction workers. Scand J Work Environ Health 2015; 41 (03) 280-287
    CrossrefPubMedGoogle Scholar
  • 49 Smoller JW, Pollack MH, Wassertheil-Smoller S. , et al. Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women's Health Initiative Observational Study. Arch Gen Psychiatry 2007; 64 (10) 1153-1160
    CrossrefPubMedGoogle Scholar
  • 50 Araki A, Murotani Y, Kamimiya F, Ito H. Low well-being is an independent predictor for stroke in elderly patients with diabetes mellitus. J Am Geriatr Soc 2004; 52 (02) 205-210
    CrossrefPubMedGoogle Scholar
  • 51 Riaz BK, Chowdhury SH, Karim MN, Feroz S, Selim S, Rahman MR. Risk factors of hemorrhagic and ischemic stroke among hospitalized patients in Bangladesh--A case control study. Bangladesh Med Res Counc Bull 2015; 41 (01) 29-34
    PubMedGoogle Scholar
  • 52 Egido JA, Castillo O, Roig B. , et al. Is psycho-physical stress a risk factor for stroke? A case-control study. J Neurol Neurosurg Psychiatry 2012; 83 (11) 1104-1110
    CrossrefPubMedGoogle Scholar
  • 53 Ranjit N, Diez-Roux AV, Shea S. , et al. Psychosocial factors and inflammation in the multi-ethnic study of atherosclerosis. Arch Intern Med 2007; 167 (02) 174-181
    CrossrefPubMedGoogle Scholar
  • 54 Ford DE, Erlinger TP. Depression and C-reactive protein in US adults: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2004; 164 (09) 1010-1014
    CrossrefPubMedGoogle Scholar
  • 55 Luna JM, Moon YP, Liu KM. , et al. High-sensitivity C-reactive protein and interleukin-6-dominant inflammation and ischemic stroke risk: the northern Manhattan study. Stroke 2014; 45 (04) 979-987
    CrossrefPubMedGoogle Scholar
  • 56 Kaptoge S, Di Angelantonio E, Lowe G. , et al; Emerging Risk Factors Collaboration. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 2010; 375 (9709): 132-140
    CrossrefPubMedGoogle Scholar
  • 57 Chuang SY, Bai CH, Chen WH, Lien LM, Pan WH. Fibrinogen independently predicts the development of ischemic stroke in a Taiwanese population: CVDFACTS study. Stroke 2009; 40 (05) 1578-1584
    CrossrefPubMedGoogle Scholar
  • 58 Centre for Reviews and Dissemination. Systematic Reviews - CRD's guidance for undertaking reviews in health care. 2009. Available at: https://www.york.ac.uk/crd/guidance/ . Accessed September 1, 2016
    PubMedGoogle Scholar
  • 59 Ohira T, Iso H, Satoh S. , et al. Prospective study of depressive symptoms and risk of stroke among japanese. Stroke 2001; 32 (04) 903-908
    CrossrefPubMedGoogle Scholar
  • 60 Ohlin B, Nilsson PM, Nilsson J-A, Berglund G. Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men. Eur Heart J 2004; 25 (10) 867-873
    CrossrefPubMedGoogle Scholar
  • 61 Jood K, Redfors P, Rosengren A, Blomstrand C, Jern C. Self-perceived psychological stress and ischemic stroke: a case-control study. BMC Med 2009; 7: 53
    CrossrefPubMedGoogle Scholar