Associations between posttraumatic stress and stroke: A systematic review and meta-analysis

The objective of the present study was to systematically review the existing literature for studies examining the association between posttraumatic stress disorder (PTSD) and stroke risk and perform a meta-analysis to obtain a pooled risk estimate describing the association. A literature search was conducted in PubMed, Embase, PSYCInfo, and CINAHL to identify relevant studies. Cohort and cross-sectional studies that reported PTSD exposure (i.e., PTSD diagnosis, probable PTSD, or the presence of PTSD symptoms) at baseline and the risk or odds of stroke associated with PTSD exposure during the study period were included in the analysis. A random-effects model was used to calculate the pooled hazard ratio (HR) for cohort studies estimating the association between PTSD and stroke. Overall, 11 studies met the inclusion criteria; eight were cohort studies, and three were cross-sectional studies. Two cohort studies and all cross-sectional studies used self-report of PTSD symptoms to measure the exposure. The pooled hazard ratio for the eight cohort studies showed that having PTSD was associated with a 59% higher risk of incident stroke, HR = 1.59, 95% CI [1.36, 1.86], I-2 = 81%. The association remained statistically significant in a subgroup analysis of six United States-based studies, HR = 1.38; 95% CI [1.29, 1.49], I-2 = 18%. The findings suggest that PTSD is associated with an increased risk of stroke. More studies are required to explore a causal association between PTSD and stroke.