The Link Between Depressive Symptoms and Stroke Risk in Black and White Individuals

Does race affect the risk of stroke in patients with depression? A new study finds some answers and some new questions.


A recent collaborative study1 led by researchers at the University of Alabama at Birmingham and the University of Alabama showed that there is a link between depressive symptoms and increased risk for stroke. While the study did not find a higher risk in either black or white individuals, they did find that those who scored higher on a test measuring depressive symptoms had a higher stroke risk than those with lower scores.

“There are a number of well-known risk factors for stroke, such as high blood pressure, diabetes and heart disease; but we are beginning to understand that there are nontraditional risk factors as well, and having depressive symptoms looms high on that list,” Virginia Howard, PhD, professor in the Department of Epidemiology in the UAB School of Public Health and senior author of the paper, said to the press. “These nontraditional risk factors need to be in the conversation about stroke prevention.”2

The participants included 14,516 white and 9,529 black participants aged 45 and older who did not have history of stroke. All participants were enrolled in the UAB-led REGARDS study, a national population-based longitudinal study that examines risk factors connected to racial and regional mortality disparities.

The 4-item Center for Epidemiologic Studies Depression Scale (CES-D-4) was utilized to assess depressive symptoms. Each participant was asked how often they felt depressed, sad, lonely, or needed to cry in a baseline evaluation.

Participants with CED-D-4 scores of 1 to 3 were found to have a 39% increased stroke risk, whereas participants with CES-D-4 scores of 4 or more had a 54% increased stroke risk, with no evidence of an increased risk in either race.

Since black individuals, especially in the southern United States, have an increased risk for stroke, a goal of the study was to help explain what factors might be causing this risk.

“The traditional risk factors don’t explain all the difference in stroke risk between races,” said Cassandra Ford, PhD, RN, Capstone College of Nursing at the University of Alabama and the study’s first author, to the press. “The results have been mixed among the few studies that enrolled Black participants and examined race and depressive symptoms in relation to stroke. Depression often goes undetected and undiagnosed in Black patients, who are frequently less likely to receive effective care and management. These findings suggest that further research needs to be conducted to explore nontraditional risk factors for stroke. The implications of our findings underscore the importance of assessing for this risk factor in both populations.”2

While the evidence needed to explain black individuals’ higher risk for stroke was not found, a major takeaway, according to the researchers, is that medical professionals need to recognize that depressive symptoms do suggest a higher stroke risk.


1. Ford CD, Gray MS, Crowther MR, Wadley VG, et al. Depressive symptoms and risk of stroke in a national cohort of blacks and whites from REGARDS. Neurol Clin Pract. October 6, 2020.

2. University of Alabama at Birmingham. Study highlights link between depressive symptoms and stroke risk. News release. October 29, 2020.

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