The correlation between perceived psychosocial stress and stroke: a meta-analysis

Abstract

Objective: This meta-analysis aimed to evaluate the association between perceived psychosocial stress and stroke. Methods: We systematically searched PubMed, Web of Science, Embase and Cochrane Library until March 2025. Published studies reporting adjusted odds ratios (ORs), hazard ratios (HRs), or relative risks (RRs) for stroke in perceived psychosocial stress versus non-perceived psychosocial stress individuals and perceived stress in stroke versus non-stroke individuals were included. A random-effects model was used to pool effect estimates, with heterogeneity assessed via the chi-square test based on Cochrane Q statistics. Subgroup evaluations were conducted for stroke type (ischemic/hemorrhagic), region, and sex. Results: Eleven case–control studies were included, with the case group comprising stroke patients (n = 21,024) and the control group consisting of healthy individuals matched for other characteristics (n = 22,408). Meta-analysis revealed a higher incidence of perceived psychosocial stress in the stroke population compared to the control group (RR = 1.58, 95% CI [1.17–1.80], p < 0.00001, I2 = 84%), with statistically significant differences. Subgroup analyses were conducted for regions: Europe and America (RR = 1.53, 95% CI [1.19–1.95], p = 0.0007); Asia (RR = 2.10, 95% CI [1.37–2.91], p = 0.0006); stroke types: ischemic stroke (RR = 1.58, 95% CI [1.30–1.91], p < 0.0001); hemorrhagic stroke (RR = 1.43, 95% CI [1.33–1.53], p < 0.00001); Sex: Male (RR = 1.58, 95% CI [1.44–1.73], p < 0.00001); Female (RR = 1.38, 95% CI [1.27–1.51], p < 0.00001); and Age < 50 years (RR = 1.50, 95% CI [1.24–1.83], p < 0.0001). Fourteen prospective cohort studies were included, with 107,741 participants in the perceived stress group and 69,784 in the control group. The results showed that the perceived stress group had a higher probability of stroke than the control group, but the difference was not statistically significant (RR = 1.29, 95% CI [0.83–2.02], p = 0.26, I2 = 99%). Subgroup analyses for Europe and America (RR = 1.65, 95% CI [0.88–3.07], p = 0.12) and Asia (RR = 1.06, 95% CI [0.82–1.38], p = 0.64) also showed no statistically significant differences. No significant associations were found for ischemic stroke (RR = 0.94, 95% CI [0.75–1.17], p = 0.57), hemorrhagic stroke (RR = 0.97, 95% CI [0.73–1.29], p = 0.83), or by Sex (Male: RR = 1.95, 95% CI [0.87–4.36], p = 0.11; Female: RR = 0.59, 95% CI [0.18–1.96], p = 0.39). Conclusion: Meta-analysis of case–control studies demonstrated that perceived psychosocial stress is a risk factor for stroke, ischemic stroke, and hemorrhagic stroke in both Europe/America and Asia, regardless of sex, particularly among stroke patients Age < 50. However, prospective cohort studies revealed no significant differences in the probability of stroke, ischemic stroke, or hemorrhagic stroke between the perceived stress and control groups across regions (Europe/America and Asia) and Sex (males and females). Meta-analysis registration: PROSPERO2025; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251012354.