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Seniorsí psychosocial distress linked to stroke risk

Monday December 17, 2012
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People over age 65 with high psychosocial distress face an increased risk of stroke, according to a study.

In a 10-year study, researchers analyzed 2,649 participants in the Chicago Health and Aging Project for rates of incident stroke. Participants were age 65 or older (average age 77, 62% women, 61% African American). The researchers identified 151 deaths from stroke and 452 events that led to first-time hospitalization for stroke.

Those with the most psychosocial distress — which includes depression, stress, a negative outlook and dissatisfaction with life — had three times the risk of death from stroke and a 54% increased risk of first hospitalization from stroke compared to those least distressed. The impact of psychosocial distress on stroke risk did not differ by race or by sex, the researchers said.

"People should be aware that stress and negative emotions often increase with age," Susan Everson-Rose, PhD, MPH, the studyís senior author and an associate professor of medicine and associate director of the Program in Health Disparities Research at the University of Minnesota in Minneapolis, said in a news release. "Family members and caregivers need to recognize these emotions have a profound effect on health."

In a separate analysis, researchers found a striking association between psychosocial distress and risk of hemorrhagic stroke, but not ischemic stroke. "There was about 70% excess risk for each unit increase in distress that wasnít explained by known stroke risk factors," Everson-Rose said. "So there must be other biologic pathways at plays linking distress to hemorrhagic stroke in particular."

The researchers measured psychosocial distress by four indicators: perceived stress, life dissatisfaction, neuroticism and depressive symptoms. They used standardized rating scales, such as the six-item Perceived Stress Scale, to determine the score of each indicator. For each indicator, higher scores represent a higher level of psychosocial distress. A distress factor score was based on averaging the values of the psychosocial measures.

The researchers conducted in-depth interviews in homes in three stable neighborhoods on the South Side of Chicago representing African Americans and Caucasians from the same socioeconomic spectrum. The interviews covered medical history, cognitive function, socioeconomic status, behavioral patterns, traditional risk factors for stroke and psychosocial characteristics.

Stroke deaths were verified by the National Death Index, and stroke hospitalizations were based on Medicare claims from the Centers for Medicare & Medicaid Services.

"Itís important to pay attention when older people complain of distress and recognize that these symptoms have physical effects on health outcomes and clearly affect stroke risk," Everson-Rose said.

The study appeared Dec. 13 on the website of Stroke, a journal of the American Heart Association. A PDF of the study is available at http://stroke.ahajournals.org/content/early/2012/12/13/STROKEAHA.112.679159.abstract.


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