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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Evidence of perceived psychosocial stress as a risk factor for stroke in adults: A meta-analysis
Author(s): Booth, Joanne
Connelly, Lesley
Lawrence, Maggie
Chalmers, Campbell
Joice, Sara
Becker, Clarissa
Dougall, Nadine
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Keywords: Stress, Psychological
Risk factor
Issue Date: 12-Nov-2015
Date Deposited: 9-Dec-2015
Citation: Booth J, Connelly L, Lawrence M, Chalmers C, Joice S, Becker C & Dougall N (2015) Evidence of perceived psychosocial stress as a risk factor for stroke in adults: A meta-analysis. BMC Neurology, 15 (1), Art. No.: 233.
Abstract: Background  Several studies suggest that perceived psychosocial stress is associated with increased risk of stroke; however results are inconsistent with regard to definitions and measurement of perceived stress, features of individual study design, study conduct and conclusions drawn and no meta-analysis has yet been published. We performed a systematic review and meta-analysis of studies assessing association between perceived psychosocial stress and risk of stroke in adults.The results of the meta-analysis are presented.  Methods  Systematic searches of MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews were undertaken between 1980 and June 2014. Data extraction and quality appraisal was performed by two independent reviewers. Hazard ratios (HR) and odds ratios (OR) were pooled where appropriate.  Results 14 studies were included in the meta-analysis, 10 prospective cohort, 4 case–control design. Overall pooled adjusted effect estimate for risk of total stroke in subjects exposed to general or work stress or to stressful life events was 1.33 (95% confidence interval [CI], 1.17, 1.50;P < 0.00001). Sub-group analyses showed perceived psychosocial stress to be associated with increased risk of fatal stroke (HR 1.45 95% CI, 1.19,1.78;P = 0.0002), total ischaemic stroke (HR 1.40 95% CI, 1.00,1.97;P = 0.05) and total haemorrhagic stroke (HR 1.73 95% CI, 1.33,2.25;P > 0.0001).A sex difference was noted with higher stroke risk identified for women (HR 1.90 95% CI, 1.4, 2.56:P < 0.0001) compared to men (HR 1.24 95% CI, 1.12, 1.36;P < 0.0001).  Conclusions  Current evidence indicates that perceived psychosocial stress is independently associated with increased risk of stroke.
DOI Link: 10.1186/s12883-015-0456-4
Rights: © 2015 Booth et al. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
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