Surtees P G, Wainwright N W J, Luben R N, Wareham N J, Bingham S A, Khaw K-T
Strangeways Research Laboratory, University of Cambridge, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK.
Neurology. 2008 Mar 4;70(10):788-94. doi: 10.1212/01.wnl.0000304109.18563.81.
Studies have suggested that mood status is associated with an increased risk of stroke, though mostly based on measures of depression defined by symptoms alone rather than diagnostic criteria representative of clinically important distress and impairment. We investigated this association based upon a large population-based prospective cohort study.
Baseline assessment of major depressive disorder (MDD) and of mental health well-being (defined by the Mental Health Inventory, MHI-5) was completed by 20,627 stroke-free participants, aged 41 to 80 years, in the United Kingdom European Prospective Investigation into Cancer-Norfolk study.
During 8.5 years of follow-up, 595 incident (fatal and nonfatal) stroke endpoints were recorded. Neither past year nor lifetime MDD was associated with stroke. A one SD decrease in MHI-5 scale score (representing greater emotional distress) was associated with an 11% increased risk of stroke after adjustment for age, sex, cigarette smoking, systolic blood pressure, cholesterol, obesity, preexisting myocardial infarction, diabetes, social class, education, hypertension treatment, family history of stroke, and antidepressant medication use (hazard ratio 1.11, 95% CI 1.00 to 1.22). This association was consistent for men and for women, for fatal and nonfatal stroke, and conformed to a dose-response relationship.
Findings from this large prospective cohort study suggest that increased psychological distress is associated with elevated stroke risk. Episodic major depressive disorder was not associated with incident stroke in this study.
研究表明情绪状态与中风风险增加有关，不过大多仅基于症状定义的抑郁测量，而非代表临床上重要困扰和损害的诊断标准。我们基于一项大型人群前瞻性队列研究调查了这种关联。
在英国欧洲癌症前瞻性调查-诺福克研究中，20627名年龄在41至80岁之间无中风的参与者完成了对重度抑郁症（MDD）和心理健康状况（由心理健康量表MHI-5定义）的基线评估。
在8.5年的随访期间，记录了595个中风终点事件（致命和非致命）。过去一年或终生的MDD均与中风无关。在校正年龄、性别、吸烟、收缩压、胆固醇、肥胖、既往心肌梗死、糖尿病、社会阶层、教育程度、高血压治疗、中风家族史和抗抑郁药物使用后，MHI-5量表得分降低一个标准差（代表更大的情绪困扰）与中风风险增加11%相关（风险比1.11，95%可信区间1.00至1.22）。这种关联在男性和女性中、致命和非致命中风中均一致，且符合剂量反应关系。
这项大型前瞻性队列研究的结果表明，心理困扰增加与中风风险升高有关。在本研究中，发作性重度抑郁症与中风事件无关。
