Healthy Lifestyles and Post-Stroke Depression: A NHANES-Based Cross-sectional Study of Stroke Survivors

BackgroundPost-stroke depression (PSD) is a common complication that seriously affects the recovery and quality of life of stroke survivors. Although individual lifestyle factors are associated with reduced risk of depression, the combined associations remain unclear. The aim of this research was to investigate the relationship between combined healthy lifestyles and the risk of PSD. MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2020, including 715 stroke survivors (mean age: 61.3 years, 51.61% male). A healthy lifestyle score (0-5) was constructed based on adherence to five favorable lifestyle behaviors, including current nonsmoking, low-to-moderate alcohol drinking, adequate physical activity, healthy diet, and optimal waist circumference. PSD was assessed using the Patient Health Questionnaire-9 (PHQ-9), with a score [≥]9 indicating depression. Multivariable logistic regression models, adjusted for demographic and clinical confounders, were used to estimate associations. ResultsIn this study population, 68.53% were non-smokers, 55.10% drank alcohol moderately, 18.04% exercised regularly, 40.00% ate a healthy diet, and 13.15% had an ideal waist circumference. Compared to those with 0-1 health behaviors, those with 3-5 had a 52% lower risk of PSD (OR=0.48, 95% CI: 0.29-0.78); each additional health behavior was associated with a 30% lower risk of PSD (OR=0.70, 95% CI. 0.58-0.84). This result persisted across sensitivity analyses. ConclusionAdherence to healthy lifestyles may help reduce the risk of PSD. This result highlights the crucial role of incorporating lifestyle-based interventions into post-stroke rehabilitation, and the potential benefits to both physical and mental health.