Self-perceived acute psychological stress and risk of mortality, recurrence and disability after stroke: Mashhad Stroke Incidence Study.

Affiliation

Mokhber N(1)(2), Sheikh Andalibi MS(3), Morovatdar N(4), Thrift AG(5), Kapral MK(6)(7), Stranges S(8)(9)(10), Saber H(11), Farzadfard MT(12), Amiri A(12), Akbarzadeh F(13), Ghanei N(13), Khorram B(12), Azarpazhooh MR(8)(12)(14).
Author information:
(1)Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran.
(2)Department of Psychiatry & Behavioral Neurosciences, Western University, London, Canada.
(3)International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
(4)Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
(5)Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Clayton, Australia.
(6)Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
(7)Institute for Clinical Evaluative Sciences, Toronto, Canada.
(8)Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
(9)Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.
(10)Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
(11)David Geffen School of Medicine, Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles, USA.
(12)Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
(13)Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
(14)Department of Clinical Neurological Science, University Hospital, London Health Science Center, Western University, London, Canada.

Abstract

This longitudinal study was designed to evaluate the association between acute pre-stroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first-ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe pre-stroke stress in the 2 weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute pre-stroke stress and study outcomes. Among 624 patients with FES, 169 reported acute pre-stroke stress. Patients with acute pre-stroke stress were younger than those without stress (60.7 ± 14.4 vs. 66.2 ± 14.7; p < 0.001). The frequency of traditional vascular risk factors was not different in patients with and without acute pre-stroke stress. We did not find any association between acute pre-stroke stress and stroke outcomes. Although acute stress was common in our cohort, our results did not support an association between acute pre-stroke stress and the severity of stroke at admission and long-term stroke outcomes.