Distress Tied to Higher Risk of Stroke

Dec. 13, 2012 -- Older adults with high levels of distress are more likely to have certain kinds of strokes than those who aren’t as troubled, a new study shows.

Distress is a combined measure of stress, depression, negativity, and dissatisfaction with life.

“It’s really trying to capture more than negative mood. A lot of studies have looked a depression and how it relates to heart disease or stroke risk, and in this case what we really wanted to get at was a general tendency to have a negative outlook on life,” says researcher Susan A. Everson-Rose, PhD, MPH, associate director of the Program in Health Disparities Research at the University of Minnesota in Minneapolis.

For the study, researchers surveyed more than 4,000 adults over age 65 in the three neighborhoods in Chicago. The majority of people who took part were women and African-American. Their average age was 77.

Each person in the study gave a detailed medical history. They also answered questions about their income, education, daily functioning, and mental outlook.

After an average of seven years, 452 people in the study were hospitalized for strokes, and at least 151 people died of one.

After researchers accounted for other known risk factors for stroke, like smoking, high blood pressure, chronic health conditions, weight, and age, they found that high levels of distress were associated with having an increased risk for having a hemorrhagic stroke, or a stroke caused by bleeding in the brain, rather than the more common stroke caused by a blood clot.

Researchers say they were surprised by that finding.  

“Everything I knew about how measures of distress or depression link to heart disease and stroke went through [clotting] mechanisms. I’m really curious about what the biological mechanisms might be, but that’s really a task for future studies,” Everson-Rose says.

People in the study with the highest levels of distress also had roughly twice the risk of dying of a stroke compared to those with little distress.

The study doesn’t prove that distress causes strokes. Instead, it shows relationships between distress and health that are probably more complicated than simple cause and effect.

Gabor Toth, MD, a vascular neurologist at the Cleveland Clinic in Ohio, says it would be nice to find out more about how distress and stroke are related.

“It may just be that you don’t take care of yourself when you’re under a lot of stress and don’t eat well,  you smoke more. But at the same time, there could be some kind of hormonal, metabolic changes in the body that are brought on by stress that put you at a higher risk for stroke,” says Toth, who wasn’t involved in the research. 

Whatever the connection may be, researchers say understanding that distress and poor health can go hand in hand is important.

“It’s really recognizing this general negativity, these emotions around distress, and realizing that they can have a physical impact,” Everson-Rose says. “It’s important to pay attention to them and find ways to alleviate the distress. Emotional states can have strong effects.”

The study was funded by the National Heart, Lung, and Blood Institute. It’s published in the journal Stroke.

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