Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).
National Institute of Public Health, University of Southern Denmark, Copenhagen (N.S., L.C.T.).
Stroke. 2022 Jul;53(7):2287-2298. doi: 10.1161/STROKEAHA.121.037740. Epub 2022 Mar 23.
Accurate estimates of risks of poststroke outcomes from large population-based studies can provide a basis for public health policy decisions. We examined the absolute and relative risks of a spectrum of incident mental disorders following ischemic stroke and intracerebral hemorrhage.
During 2004 to 2018, we used Danish registries to identify patients (≥18 years and with no hospital history of mental disorders), with a first-time ischemic stroke (n=76 767) or intracerebral hemorrhage (n=9344), as well as age-,sex-, and calendar year-matched general population (n=464 840) and myocardial infarction (n=92 968) comparators. We computed risk differences, considering death a competing event, and hazard ratios adjusted for income, occupation, education, and history of cardiovascular and noncardiovascular comorbidity.
Compared with the general population, following ischemic stroke, the 1-year risk difference was 7.3% (95% CI, 7.0-7.5) for mood disorders (driven by depression), 1.4% (95% CI, 1.3-1.5) for organic brain disorders (driven by dementia and delirium), 0.8% (95% CI, 0.7-0.8) for substance abuse disorders (driven by alcohol and tobacco abuse), and 0.5% (95% CI, 0.4-0.5) for neurotic disorders (driven by anxiety and stress disorders). For suicide, risk differences were near null. Hazard ratios were particularly elevated in the first year of follow-up, ranging from a 2- to a 4-fold increased hazard, decreasing thereafter. Compared with myocardial infarction patients, the 1-year risk difference was 4.9% (95% CI, 4.6 to 5.3) for mood disorders, 1.0% (95% CI, 0.8 to 1.1) for organic brain disorders, 0.1% (95% CI, 0.0 to 0.2) for substance abuse disorders, but -0.2% (95% CI, -0.2 to -0.1) for neurotic disorders. Hazard ratios during the first year of follow-up were elevated 1.1- to 1.8-fold for mood, organic brain, and neurotic disorders, while decreased 0.8-fold for neurotic disorders.
The considerably greater risks of mental disorders following a stroke, particularly mood disorders, underline the importance of mental health evaluation after stroke.
从大型基于人群的研究中准确估计卒中后结局的风险，可以为公共卫生政策决策提供依据。我们研究了缺血性卒中和脑出血后一系列首发精神障碍的绝对和相对风险。
在 2004 年至 2018 年期间，我们使用丹麦的登记处来确定患者（≥18 岁，无精神障碍住院史），包括首次缺血性卒中和脑出血（n=76767）或脑出血（n=9344），以及年龄、性别和日历年份匹配的一般人群（n=464840）和心肌梗死（n=92968）对照组。我们计算了风险差异，将死亡视为竞争事件，并调整了收入、职业、教育以及心血管和非心血管合并症的风险比。
与一般人群相比，缺血性卒中后 1 年的风险差异为 7.3%（95%CI，7.0-7.5），为心境障碍（由抑郁症引起），1.4%（95%CI，1.3-1.5）为器质性脑障碍（由痴呆和谵妄引起），0.8%（95%CI，0.7-0.8）为物质使用障碍（由酒精和烟草滥用引起），0.5%（95%CI，0.4-0.5）为神经症障碍（由焦虑和应激障碍引起）。对于自杀，风险差异接近零。风险比在随访的第一年特别升高，从 2 倍到 4 倍增加的风险，此后下降。与心肌梗死患者相比，1 年的风险差异为 4.9%（95%CI，4.6-5.3）为心境障碍，1.0%（95%CI，0.8-1.1）为器质性脑障碍，0.1%（95%CI，0.0-0.2）为物质使用障碍，但为 0.2%（95%CI，0.2-0.1）为神经症障碍。在随访的第一年，心境、器质性脑和神经症障碍的风险比升高 1.1 至 1.8 倍，而神经症障碍则降低 0.8 倍。
卒中后精神障碍的风险明显增加，尤其是心境障碍，这突显了卒中后进行心理健康评估的重要性。
