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Meta-Analysis
. 2023 Apr;36(2):259-271.
doi: 10.1002/jts.22925. Epub 2023 Mar 29.

Associations between posttraumatic stress and stroke: A systematic review and meta-analysis

Hely D Nanavati  1 , Andrea Arevalo  2 , Adeel A Memon  3 , Chen Lin  2
Affiliations
Meta-Analysis

Associations between posttraumatic stress and stroke: A systematic review and meta-analysis

Hely D Nanavati et al. J Trauma Stress. 2023 Apr.

Abstract

The objective of the present study was to systematically review the existing literature for studies examining the association between posttraumatic stress disorder (PTSD) and stroke risk and perform a meta-analysis to obtain a pooled risk estimate describing the association. A literature search was conducted in PubMed, Embase, PSYCInfo, and CINAHL to identify relevant studies. Cohort and cross-sectional studies that reported PTSD exposure (i.e., PTSD diagnosis, probable PTSD, or the presence of PTSD symptoms) at baseline and the risk or odds of stroke associated with PTSD exposure during the study period were included in the analysis. A random-effects model was used to calculate the pooled hazard ratio (HR) for cohort studies estimating the association between PTSD and stroke. Overall, 11 studies met the inclusion criteria; eight were cohort studies, and three were cross-sectional studies. Two cohort studies and all cross-sectional studies used self-report of PTSD symptoms to measure the exposure. The pooled hazard ratio for the eight cohort studies showed that having PTSD was associated with a 59% higher risk of incident stroke, HR = 1.59, 95% CI [1.36, 1.86], I2 = 81%. The association remained statistically significant in a subgroup analysis of six United States-based studies, HR = 1.38; 95% CI [1.29, 1.49], I2 = 18%. The findings suggest that PTSD is associated with an increased risk of stroke. More studies are required to explore a causal association between PTSD and stroke.

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Conflict of interest statement

AUTHOR NOTE

The authors have no conflicts of interest to declare. A study protocol was prepared and submitted to PROSPERO on June 16, 2020 (Registration no.: CRD42020184223). The protocol has been amended twice, with the final amendment highlighting the changes in the author list as well as the analytic strategy.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study selection Note: PTSD = posttraumatic stress disorder.
FIGURE 2
FIGURE 2
Forest plot of associations between posttraumatic stress disorder (PTSD) and stroke in included cohort studies Note: CI = confidence interval.
FIGURE 3
FIGURE 3
Forest plot of associations between posttraumatic stress disorder (PTSD) and stroke in United States–based cohort studies Note: CI = confidence interval.
See this image and copyright information in PMC

References

    1. Beristianos MH, Yaffe K, Cohen B, & Byers AL (2016). PTSD and risk of incident cardiovascular disease in aging veterans. American Journal of Geriatric Psychiatry, 24(3), 192–200. 10.1016/j.jagp.2014.12.003 - DOI - PubMed
    1. Blanchard EB, Jones-Alexander J, Buckley TC, & Forneris CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour research and therapy, 34(8), 669–673. 10.1016/0005-7967(96)00033-2 - DOI - PubMed
    1. Boehme AK, Esenwa C, & Elkind MSV (2017). stroke risk factors, genetics, and prevention. Circulation Research, 120(3), 472–495. 10.1161/circresaha.116.308398 - DOI - PMC - PubMed
    1. Brass LM, & Page WF (1996). Stroke in former prisoners of war. Journal of Stroke and Cerebrovascular Diseases, 6(2), 72–78. 10.1016/s1052-3057(96)80006-1 - DOI - PubMed
    1. Breslau N, Davis GC, & Schultz LR (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry, 60(3), 289–294. 10.1001/archpsyc.60.3.289 - DOI - PubMed

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