Psychiatric Hospitalization Increases Short-Term Risk of Stroke

Abstract

Background and Purpose— Recent evidence suggests that psychological distress, including the symptoms of psychiatric illness, may acutely increase the risk of stroke. However, existing studies are limited by small sample sizes, inherent recall bias, and poorly defined criteria for what constitutes psychological distress. Methods— We analyzed administrative data from the Healthcare Cost and Utilization Project for the state of California from 2007 to 2009 using a case-crossover design. Conditional logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for combined hemorrhagic and ischemic stroke risk occurring within 15, 30, 90, 180, and 365 days of a hospitalization for a psychiatric diagnosis (as defined by International Classification of Diseases, Ninth Revision , code) among adults. Results— Psychiatric hospitalizations within 1 year before stroke were found in 2585 (5.3%) of 48 558 stroke patients. Hospitalization for a psychiatric condition was associated with increased risk of stroke within all 5 time periods, with the highest odds of stroke occurring within 15 days (0–15 days: OR, 3.5; 95% confidence interval [CI], 2.6–4.8; 0–30 days: OR, 3.0; 95% CI, 2.4–3.8; 0–90 days: OR, 2.3; 95% CI, 2.0–2.7; 0–180 days: OR, 2.2; 95% CI, 2.0–2.5; and 0–365 days: OR, 2.6; 95% CI, 2.4–2.8). Conclusions— Psychiatric hospitalization increases the short-term risk of stroke, particularly within the 15-day period after hospitalization.