Association between psychiatric disorders and the risk of stroke: a meta-analysis of cohort studies

Abstract

Background: Psychiatric disorders may be associated with an elevated risk of stroke; however, the existence of variations in this association between different populations remains controversial. Consequently, we conducted a comprehensive systematic review and meta-analysis to examine the magnitude of the relationship between psychiatric disorders and the risk of stroke.

Methods: The PubMed, Embase, and Cochrane Library databases were systematically searched to identify eligible studies from inception to April 2024. The aggregated findings were expressed as relative risks (RRs) with 95% confidence intervals (CIs), and the combined analysis was performed using a random-effects modeling approach. Further exploratory analyses were also performed using sensitivity and subgroup analyses.

Results: A total of 36 cohort studies, involving 25,519,635 individuals, were selected for analysis. We noted that depression (RR: 1.50; 95% CI: 1.34-1.68; p < 0.001), schizophrenia (RR: 1.74; 95% CI: 1.36-2.24; p < 0.001), and bipolar disorder (RR: 1.65; 95% CI: 1.27-2.14; p < 0.001) were associated with an elevated risk of stroke. Further exploratory analyses found that the association between depression and the risk of stroke differed according to the adjusted level (RR ratio: 0.77; 95% CI: 0.61-0.98; p = 0.034), and the association between schizophrenia and the risk of stroke differed according to the outcome definition (RR ratio: 0.68; 95% CI: 0.52-0.90; p = 0.006). Moreover, the association between bipolar disorder and the risk of stroke differed according to the study design (RR ratio: 0.68; 95% CI: 0.55-0.84; p < 0.001).

Conclusion: The significant association between psychiatric disorders and an elevated risk of stroke highlights the importance of enhanced monitoring and stroke prevention in patients with psychiatric disorders.

Systematic review registration: Our study was registered on the INPLASY platform (number: INPLASY202450049).

Keywords: cohort studies; meta-analysis; psychiatric disorders; risk; stroke.