Depressive Symptoms Predict Incident Stroke Independently of Memory Impairments

MS ID#: Neurology/2009/314948

Depressive Symptoms Predict Incident Stroke Independently of Memory Impairments

Appendixe-1

The Health and Retirement Study (HRS) sampling design and measures are described in detail in online references.(e1-e3)

A portion of HRS participants (n=6,133) were previously evaluated on both CES-D and a short form of the World Health Organization’s Composite International Diagnostic Interview (CIDI-SF).(e4) The CES-D with a cutpoint of 3+ had 71% sensitivity and 79% specificity for identifying major depressive episode according to DSM-IV criteria as implemented by the CIDI-SF.(e5,e6)

Autonomic dysfunction has also been associated with the development and maintenance of atrial fibrillation (AF), a major stroke risk factor.(e7, e8)

Although depressive states are clearly linked to ventricular arrhythmias and sudden cardiac death(e11, e12), there has been little research on the relationship between affective states and AF. The limited available evidence suggests an association; for example, depression predicts recurrence of AF after cardioversion.(e9) Tension and anger, emotional states closely related to depression, predict incidence of AF in males in the Framingham Heart Study.(e10) We do not have sufficient data to directly evaluate these hypotheses, but such pathways are promising avenues for future research.

e-References

e1.Juster F, Suzman R. An overview of the health and retirement study. J Hum Resur 1995;30 (suppl):S7-S56.

e2.Heeringa SG, Connor J. Technical description of the Health and Retirement Study sample design. HRS/AHEAD Documentation Report. Ann Arbor, Michigan: Survey Research Center, University of Michigan, 1995 1995. Report No.: DR-002.

e3.Ofstedal MB, Fisher GF, Herzog AR. Documentation of cognitive functioning measures in the health and retirement study. In: HRS Documentation Report Ann Arbor, MI: Survey Research Center, University of Michigan, 2005.

e4.Turvey CL, Wallace RB, Herzog R. A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. International Psychogeriatrics 1999;11:139-148.

e5.Steffick D. Documentation of Affective Functioning Measures in the Health and Retirement Study. In: HRS Documentation Report Ann Arbor, Michigan: Survey Research Center, University of Michigan, 2000.

e6.Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H. The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research 1998;7:171-185.

e7.Olshansky B. Interrelationships between the autonomic nervous system and atrial fibrillation. Prog Cardiovasc Dis 2005;48:57-78.

e8.Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-988.

e9.Lange HW, Herrmann-Lingen C. Depressive symptoms predict recurrence of atrial fibrillation after cardioversion. Journal of psychosomatic research 2007;63:509-513.

e10.Eaker ED, Sullivan LM, Kelly-Hayes M, D'Agostino RB, Benjamin EJ. Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation 2004;109:1267-1271.

e11. Whang W, Kubzansky LD, Kawachi I, et al. Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women Results From the Nurses' Health Study. Journal of the American College of Cardiology 2009;53:950-958.

e12. Carney RM, E FK. Depression and Medical Illness. In: Berkman LF, Kawachi I, eds. Social Epidemiology. New York: Oxford University Press, 2000: 191-212.

e13.Sacco RL, Boden-Albala B, Abel G, et al. Race-ethnic disparities in the impact of stroke risk factors - The Northern Manhattan Stroke Study. Stroke 2001;32:1725-1731.