BPG is committed to discovery and dissemination of knowledge
Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Oct 19, 2025; 15(10): 108061
Published online Oct 19, 2025. doi: 10.5498/wjp.v15.i10.108061
Longitudinal trajectories of somatic and cognitive-affective depressive symptoms influence stroke risk across different populations: Three prospective cohort studies
Xue-Lun Zou, Cai-Lin He, Xin Li, Jun-Jie Jiang, Yi-Shu Tang, Gao-Yuan Cui, Wu-Yang Zhang, Chang Zhou
Xue-Lun Zou, Cai-Lin He, Gao-Yuan Cui, Department of Neurology, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Xin Li, Jun-Jie Jiang, Department of Thoracic Surgery, Central South University, Changsha 410008, Hunan Province, China
Yi-Shu Tang, Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Wu-Yang Zhang, Clinical Skills Training Center, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Chang Zhou, Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Author contributions: Zou XL and Zhou C designed the research and decided on the manuscript's structure; Zou XL, Zhou C, Li X, Jiang JJ, Tang YS, Cui GY and Zhou C chose the references and participated in the writing; Zou XL, He CL, Li X compiled the original data; Zou XL and Zhou C contributed to the analysis of these cohort results; Zhou C contributed to the manuscript’s revision and completion; all authors participated in and approved the final draft of the manuscript.
Institutional review board statement: There was no need to get informed consent or ethical approval for this study again because all of the data were taken from published sources, and the informed consent and approval were received.
Clinical trial registration statement: This study utilized previously established cohort studies; therefore, reregistration was unnecessary.
Informed consent statement: This study used previously published cohort studies; thus, there was no need to re-request informed consent.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The original contributions presented in the study are included in the manuscript. Further inquiries can be directed to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Zhou, PhD, Department of Oncology, The Third Xiangya Hospital of Central South University, Tongzipo Street, Changsha 410008, Hunan Province, China. csuzhouchang@163.com
Received: April 7, 2025
Revised: June 6, 2025
Accepted: August 8, 2025
Published online: October 19, 2025
Processing time: 175 Days and 16 Hours
Abstract
BACKGROUND

Depressive symptoms differ from clinical depression. However, the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.

AIM

To address the gap in the existing understanding of the relationship between depressive symptom trajectories and stroke risk, the current study utilized three representative cohorts.

METHODS

In this study, we used three representative cohorts from Asia, Europe, and the Americas: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression scale and categorized into somatic and cognitive-affective subtypes. The trajectories of depressive symptoms were monitored over four surveys starting from baseline and classified into five distinct states: persistently low, decreasing, fluctuating, increasing, and consistently high. Self-reported physician diagnoses were used to evaluate the subsequent stroke events. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were computed using Cox proportional-risk models adjusted for potential confounding factors.

RESULTS

A total of 7990 participants from CHARLS (females: 52.3%, mean age: 63.4 years), 5642 participants from ELSA (females: 56.2%, mean age: 63.7 years), and 12260 participants from HRS (females: 61.4%, mean age: 64.7 years) participated in this study. The median follow-up periods were 5 years for CHARLS, 8 years for ELSA, and 10 years for HRS. In comparison with the persistently low trajectory, consistently high and fluctuating trajectories of total depressive symptoms increased the risk of stroke in all three cohorts (CHARLS: HR = 1.80, 95%CI: 1.36-2.38; ELSA: HR = 1.50, 95%CI: 1.02-2.21; HRS: HR = 1.45, 95%CI: 1.29-1.62 for consistently high; CHARLS: HR = 1.47, 95%CI: 1.14-1.90; ELSA: HR = 1.44, 95%CI: 1.17-1.77; HRS: HR = 1.26, 95%CI: 1.13-1.41 for fluctuating). Increasing trajectories enhanced the risk in the European cohort (ELSA: HR = 1.71, 95%CI: 1.06-2.74), while decreasing trajectories did not increase stroke risk in any cohort. For somatic depressive symptoms, consistently high and fluctuating trajectories increased the risk of stroke across all cohorts (CHARLS: HR = 2.16, 95%CI: 1.67-2.79; ELSA: HR = 1.94, 95%CI: 1.34-2.81; HRS: HR = 1.79, 95%CI: 1.49-2.15 for consistently high; CHARLS: HR = 1.35, 95%CI: 1.20-1.62; ELSA: HR = 1.56, 95%CI: 1.27-1.92; HRS: HR = 1.33, 95%CI: 1.20-1.46 for fluctuating). Increasing trajectories only increased the risk in the European cohort (ELSA: HR = 1.95, 95%CI: 1.11-3.43), while decreasing trajectories did not increase stroke risk in the European and American cohorts. For cognitive-affective depressive symptoms, consistently high and fluctuating trajectories increased the risk in the Asian and European cohorts (CHARLS: HR = 2.06, 95%CI: 1.52-2.81; ELSA: HR = 1.25, 95%CI: 1.02-1.54 for consistently high; CHARLS: HR = 1.63, 95%CI: 1.23-2.16; ELSA: HR = 1.58, 95%CI: 1.11-2.24 for fluctuating). Increasing trajectories increased the risk only in the American cohort (HRS: HR = 14.67, 95%CI: 1.87-114.91).

CONCLUSION

Consistently high and fluctuating trajectories of total and somatic depressive symptoms were associated with an increased risk for stroke across all populations. Consistently high, fluctuating, and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations. These findings highlight the importance of targeted interventions for managing depressive symptoms as potential strategies for stroke prevention, particularly in regions where specific symptom trajectories are prevalent.

Keywords: Stroke; Depressive symptom; Cohort study; Epidemiology; Middle-aged and elderly population

Core Tip: Consistently high and fluctuating trajectories of total and somatic depressive symptoms are associated with an increased risk of stroke across all populations. Consistently high, fluctuating, and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations. These findings highlight the importance of targeted interventions to manage depressive symptoms as a potential strategy for stroke prevention, particularly in regions where specific symptom trajectories are more prevalent.