ArticleCNS spectrums2026
Global divergence of stroke and major depressive disorder: unveiling a potential "hidden stagnation" pattern through an integrated medicine perspective.
Article in CNS spectrums, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMajor depressive disorder (MDD) is associated with increased stroke risk and can be conceptualized in Traditional Chinese Medicine (TCM) as emotional constraint or "Qi Stagnation" that may contribute to "Blood Stasis." However, the country-level ecological relationship between stroke burden and MDD prevalence remains unclear, and high-stroke settings may have under-recognized MDD because of differences in data availability, diagnostic practices, mental health services, and cultural symptom expression. This study quantifies this ecological association and interprets it through an Integrated Medicine framework.
methodsUsing Global Burden of Disease (GBD) 2023 data, we analyzed age-standardized stroke Disability-Adjusted Life Year (DALY) rates for all stroke and age-standardized prevalence rates for the GBD cause category of MDD across 204 countries and territories from 1990 to 2023. An exploratory Diagnostic Gap Score (ZStroke-ZMDD) was developed to identify countries and territories with disproportionate stroke burden relative to reported MDD prevalence.
resultsA negative ecological correlation emerged globally and strengthened over time (
conclusionsLow reported MDD prevalence in high-stroke countries and territories suggests a potential diagnostic, reporting, or data-quality mismatch rather than biological protection. These ecological findings do not prove that undiagnosed MDD causes stroke burden, but they support culturally adapted mental health screening in primary care, stroke-prevention clinics, and community health settings, with referral pathways for those who screen positive.
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