{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:00:53Z","timestamp":1790179253941,"version":"4.1.0"},"reference-count":101,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychosocial stress has been recognized as a potential risk factor for stroke; however, the strength and consistency of its association with first-ever stroke remain uncertain. This systematic review and meta-analysis aimed to determine the overall association between psychosocial stress and the risk of first stroke in a stroke-free population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis in accordance with the PRISMA and MOOSE guidelines. PubMed, Scopus, Web of Science, and Ovid were searched from inception to 1 January 2026 for cohort or case\u2013control studies. Eligible studies enrolled participants without a prior history of stroke and reported adjusted risk estimates with 95% confidence intervals. Psychosocial stressors were categorized into psychological, vocational, interpersonal, and behavioral domains. Stroke outcomes included ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, transient ischemic attack, and unspecified stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-four studies were included (72 prospective cohort and 12 case\u2013control), comprising 4,128,167 participants. In cohort studies, psychological stress was associated with a higher risk of first-ever stroke (hazard ratio [HR] 1.27, 95% confidence interval 1.19\u20131.36). Vocational stressors were also associated with increased stroke risk (HR 1.32, 95% CI 1.23\u20131.43). Interpersonal stressors showed a smaller but statistically significant association (HR 1.11, 95% CI 1.03\u20131.20). Behavioral stress-related traits showed the largest effect estimate (HR 1.51, 95% CI 1.05\u20132.15), although this finding should be interpreted cautiously because it was based on only three cohort studies. In sex-stratified analyses, the association was significant among men (HR 1.19, 95% CI 1.07\u20131.32) but not among women (HR 0.86, 95% CI 0.58\u20131.28); however, the subgroup interaction was not statistically significant and should be interpreted as inconclusive rather than evidence of a definite sex-specific difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Psychosocial stress is associated with an increased risk of first-ever stroke, particularly psychological and vocational stressors, supporting psychosocial factors as potentially modifiable components of stroke prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-026-05307-4","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:35:11Z","timestamp":1790170511000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychosocial stress and risk of first-ever stroke: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7199-3939","authenticated-orcid":false,"given":"Mostafa A.","family":"Khalifa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4974-4411","authenticated-orcid":false,"given":"Diaaeldin","family":"Hassanein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0308-5651","authenticated-orcid":false,"given":"Abd Alrahman I.","family":"Alsabbagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8643-8957","authenticated-orcid":false,"given":"Ahmed Samir","family":"Gamil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8706-2514","authenticated-orcid":false,"given":"Darin Emad","family":"Abdelhaleem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1137-0970","authenticated-orcid":false,"given":"Ayham R. 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