{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T08:48:14Z","timestamp":1792486094000,"version":"4.5.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13\u202f462 patients with stroke and 13\u202f488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13\u202f350 cases and 13\u202f462 controls with available data on psychosocial stress.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 26\u202f812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58];\n P<\/jats:italic>\n =\u2009.008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98];\n P<\/jats:italic>\n &amp;lt; .001 for interaction) for acute stroke.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.44836","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T11:30:50Z","timestamp":1670585450000},"page":"e2244836","source":"Crossref","is-referenced-by-count":64,"title":["Association of Psychosocial Stress With Risk of Acute Stroke"],"prefix":"10.1001","volume":"5","author":[{"given":"Catriona","family":"Reddin","sequence":"first","affiliation":[{"name":"HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland"},{"name":"Wellcome Trust\u2013HRB, Irish Clinical Academic Training, Dublin, 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