Longitudinal associations between stroke and psychosis: a population-based study

Abstract

Background: The co-occurrence of stroke and psychosis is a serious neuropsychiatric condition, but little is known about the course of this comorbidity. Aims: To estimate longitudinal associations between stroke and psychosis over 10 years. Methods: A 10-year population-based study using data from the English Longitudinal Study of Ageing. A structured health assessment recorded i) first-occurrence stroke and ii) psychosis, at each wave. Each were considered exposures and outcomes in separate analyses. Logistic and Cox proportional hazards regression and Kaplan-Meier methods were used. Models were adjusted for demographic and health behaviour covariates, with missing covariates imputed using random forest multiple imputation. Results: Of 19,808 participants, 24 reported both stroke and psychosis (median Wave 1 age 63, 71% female, 50% lowest quintile of net financial wealth) at any point during follow-up. By 10 years, the probability of an incident first stroke in participants with psychosis was 21.4% (95% CI, 12.1 to 29.6) compared to 8.3% (95% CI, 7.8 to 8.8) in those without psychosis (absolute difference: 13.1%; 95% CI, 20.8 to 4.3, log rank p<0.001; fully-adjusted hazard ratio (HR): 3.63; 95% CI, 2.25 to 5.87). The probability of reporting incident psychosis in participants with stroke was 2.3% (95% CI, 1.4 to 3.2) compared to 0.9% (95% CI, 0.7 to 1.1) in those without (absolute difference: 1.4%; 95% CI, 0.7 to 2.1, log rank p<0.001; fully-adjusted HR: 5.81; 95% CI, 2.89 to 11.70). Conclusions: Stroke is an independent predictor of psychosis (and vice versa), after adjustment for potential confounders.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

ARB is funded by the Wellcome Trust through a PhD Fellowship in Mental Health Science. This research was funded in whole or in part by the Wellcome Trust. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript (AAM) version arising from this submission. DPJO is supported by the University College London Hospitals NIHR Biomedical Research Centre and the NIHR North Thames Applied Research Collaboration. This funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study is secondary analysis of data from the English Longitudinal Study of Ageing (ELSA). ELSA received ethical approval from the London Multicentre Research Ethics Committee (REC) (waves 1 to3, references: MREC/01/2/91, MREC/04/2006, 05/MRE02/63), National Hospital for Neurology and Neurosurgery & Institute of Neurology Joint REC (wave 4, reference: 07/H0716/48), Berkshire REC (wave 5, reference: 09/H0505/124), NRES Committee South Central Berkshire (waves 6 to 9, references: 11/SC/0374, 13/SC/0532, 15/SC/0526, 17/SC/0588). All participants provided informed consent. ELSA data are publicly accessible, data were accessed via UK Data Service (project ID: 222747). Research Ethics Committee of University College London (UCL) guidance deemed this secondary study exempt from ethical review: "Research involving anonymised records and data sets that exist in the public domain. For example, datasets available through the Office for National Statistics or the UK Data Archive where appropriate permissions have already been obtained and it is not possible to identify individuals from the information provided." https://ethics.grad.ucl.ac.uk/exemptions.php

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

English Longitudinal Study of Ageing (ELSA) data are publicly accessible; data were accessed via UK Data Service (project ID: 222747). Data cannot be shared by the authors of this article but can be obtained directly from the UK Data Service (https://ukdataservice.ac.uk/).

https://ukdataservice.ac.uk/

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