Moderate optimism or a low number of adverse life events may be protective against the risk of new-onset depression in women who have a stroke, according to findings published in the Journal of the American Heart Association.

Joel Salinas, MD, from Harvard Medical School in Boston, and colleagues based their findings on 1,424 patients from the Women’s Health Initiative. All patients were stroke‐free at the time of study enrollment, and they had no self‐reported history of depression from the time of enrollment to the time of their nonfatal ischemic stroke based on initiation of treatment for depression or use of the Burnam screening instrument for detecting depressive disorders. The researchers assessed new-onset poststroke depression (NPSD) with use of the same method during the 5‐year poststroke period. Logistic regression was used to provide odds ratios of NPSD after the investigators controlled for multiple covariates.

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Dr Salinas’ group found that NPSD occurred in 21.4% (305 of 1,424) of patients and that the rate varied by stroke severity according to score on the Glasgow scale, ranging from 16.7% of those who had a good recovery to 31.6% of those who were severely disabled. Women with total anterior circulation infarction had the highest level (31.4%) of NPSD, and women with lacunar infarction had the lowest level of NPSD (16.1%). Prestroke psychosocial measures had different associations with NPSD depending on the patient’s functional recovery.

After controlling for age at the time of stroke and race, the researchers found that women with a good recovery and a moderate level of optimism had a 0.40‐fold reduction in the odds of developing NPSD, compared with those who had low levels of optimism. In women who had a good recovery, a low level of adverse life events was also associated with a decreased odds of NPSD (compared with no events, OR, 0.52).

“There is a difference in the relationship of prestroke psychosocial status and risk of NPSD depending on stroke severity; thus it may be that the same preventive interventions might not work for all stroke patients,” stated the researchers. “One size does not fit all.

“Though rarely studied in poststroke depression, understanding how prestroke psychosocial factors, such as optimism, are associated with the risk for developing new‐onset depression after ischemic stroke may ultimately aid in improving the identification of stroke survivors at highest risk for depression who may benefit from early prevention through a targeted intervention strategy in the acute to subacute poststroke period,” the investigators concluded.


  1. Salinas J, Ray R, Nassir R, et al. Factors associated with new-onset depression following ischemic stroke: the women’s health initiative. J Am Heart Assoc. 2017;6(2). doi:10.1161/JAHA.116.003828