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(Stroke. 2002;33:5.)
© 2002 American Heart Association, Inc.

Editorials

Psychological Distress as a Risk Factor for Stroke-Related Mortality

Robert M. Carney, PhD Kenneth E. Freedland, PhD
In this issue, May et al report that psychological distress is a predictor of fatal ischemic stroke. What is "psychological distress"? It is a nonspecific term that encompasses sadness, frustration, anxiety, and a number of other negative mood states. It includes both mild and severe forms of these mood states, as well as both transient and persistent ones. It also refers both to symptoms of psychiatric disorders and to normal emotional responses to adversity.

Although several varieties of psychological distress have been investigated as potential risk factors for cardiovascular or cerebrovascular disease in community cohorts, and as risk factors for cardiac events, stroke, and mortality in patients with established coronary or cerebrovascular disease, depression is the variety of psychological distress that has received the most attention in all of these lines of research. Psychological distress, particularly in the form of depression, has a number of adverse effects in stroke patients. It impairs social functioning and quality of life¹ and interferes with the recovery of motor^2,3 and language functions.³ It may also be a risk factor for stroke and stroke-related mortality.^4–6

In a 14-year follow-up of 2201 middle-aged male participants in the Caerphilly study, May et al report that psychological distress, as measured at baseline by the 30-item version of the General Health Questionnaire (GHQ-30), was an independent risk factor for fatal ischemic stroke, after adjusting for potential confounds. In contrast, the hazard ratios for nonfatal ischemic stroke and for transient ischemic attack (TIA) were not statistically significant, even in univariate . . . [Full Text of this Article]

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