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The Association Between Emotional Well-Being and the Incidence of Stroke in Older Adults

Ostir, Glenn V. PhD; Markides, Kyriakos S. PhD; Peek, M. Kristen PhD, and; Goodwin, James S. MD


Objective Individuals with high levels of depressive symptoms have an increased risk of many illnesses, including stroke. Measures of depressive symptoms include questions about the presence of negative affect, such as sadness, as well as the absence of positive affect, such as happiness and optimism. We assessed whether positive or negative affect, or both, predicted risk of stroke.

Methods Data were from a 6-year prospective cohort study of a population-based sample of 2478 older whites and blacks from five counties in North Carolina who reported no history of stroke at the baseline interview. Baseline, in-person interviews were conducted to gather information on sociodemographic, psychosocial, and health-related characteristics of subjects. Thereafter interviews were conducted annually for 6 years.

Results Increasing scores on the modified version of the Center for Epidemiological Studies Depression Scale (CES-D) were significantly associated with stroke incidence for the overall sample (relative risk [RR] = 1.04 for each one-point increase, 95% confidence interval [CI] = 1.01–1.09) over the 6-year follow-up period after adjusting for sociodemographic characteristics, blood pressure, body mass index, smoking status, and selected chronic diseases. Positive affect score demonstrated a strong inverse association with stroke incidence (RR = 0.74, 95% CI = 0.62–0.88).

Conclusions Increasing scores on the modified CES-D are related to an increased risk of stroke, whereas high levels of positive affect seem to protect against stroke in older adults.

From the Department of Preventive Medicine and Community Health (G.V.O., K.S.M., J.S.G.), Sealy Center on Aging (G.V.O., K.S.M., M.K.P., J.S.G.), Department of Internal Medicine (J.S.G.), and Department of Health Promotion and Gerontology (M.K.P.), University of Texas Medical Branch, Galveston, Texas.

Address reprint requests to: Glenn V. Ostir, PhD, Preventive Medicine and Community Health, University of Texas Medical Branch, 700 Harborside Dr., 1.128 Ewing Hall, Galveston, TX 77555-1143. Email:

Received for publication February 4, 2000; revision received May 3, 2000.

Copyright © 2001 by American Psychosomatic Society
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