Psychosocial stress increases susceptibility to intracerebral haemorrhage

Psychosocial stress has emerged as a significant risk factor for intracerebral haemorrhage (ICH), both lobar and nonlobar, in a study that controlled for hypertension and other commonly associated risk factors.

For the study, researchers used data from the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study, a case–control study of ICH among White, Black, and Hispanic patients. Matching was performed according to sex and race or ethnicity.

Psychosocial stress was assessed using a self-reported 10-point scale, where participants rated the intensity of four stress subtypes—financial, health, emotional well-being, and family—experienced in the week prior to ICH. The association of each stress type with ICH was examined using univariate and multivariable logistic regressions. Mediation analyses were also performed to determine whether hypertension mediated the association between stress and ICH.

The analysis included a total of 2,964 cases (mean age 62.1 years, 58.6 percent male, 33.7 percent Black) and 2,964 controls (mean age 61.6 years, 58.6 percent male, 33.7 percent Black). Around 23 percent of cases indicated significant stress (6/10 or higher) across all types of psychosocial stress. 

Compared with no stress (0/10), maximal stress (10/10) was associated with increased odds of ICH. This was true for emotional well‐being stress (odds ratio [OR], 4.2, 95 percent confidence interval [Cl], 3.0–5.8; p<0.0001), health‐related stress (OR, 3.6, 95 percent CI, 2.7–4.9; p<0.0001), family‐related stress (OR, 2.6, 95 percent CI, 2.1–3.2; p<0.0001), and financial stress (OR, 2.3, 95 percent CI, 1.9–2.9; p<0.0001).

Notably, financial stress was associated with increased odds of nonlobar ICH, and this association was especially pronounced among Black and Hispanic patients.

Hypertension mediated the effects of health, emotional well‐being, and family stress on the risk of ICH.

The findings point to a new target for ICH risk mitigation and highlight the need to study the mechanisms underlying the association.