Risk of haemorrhagic strokes in patients with psychiatric disorders: A systematic review and meta-analysis

Abstract

Objectives

Strong evidence on the risk of haemorrhagic strokes for those with psychiatric conditions may lead to more effective interventions for mental health patients and inform future studies. This systematic review aimed to identify all the studies that compare the risk of haemorrhagic stroke for patients with and without depression, anxiety, schizophrenia, bipolar or personality disorders. It also aimed to provide a summary estimate of the risk, where possible, using meta-analysis.

Methods

Electronic searches were conducted in Embase, PsycINFO, PubMED, Scopus and the Web of Science, from database inception to the 11th of March 2025. A Random-effects model to estimate the pooled effect size with 95% confidence intervals was used.

Results

17,214 references were initially identified. Eleven articles were included. Seven of them, five observational and two mendelian randomisation studies, investigated depression. In the meta-analysis depression showed a significant association with an increased risk of haemorrhagic stroke, with pooled HR: 1.28 (1.19–1.38) when only observational studies were included. When mendelian randomisation studies were added the result was a pooled HR: 1.26 (1.08–1.44). The risk of haemorrhagic stroke was increased in one of the three studies that investigated patients with anxiety disorders and in one of the three that looked at patients with schizophrenia. Two studies of bipolar disorder, and one of personality disorders, reported that patients with these conditions do not have an increased risk of haemorrhagic stroke.

Conclusion

Patients with depression have an increased risk of haemorrhagic stroke. The association of mental illness with haemorrhagic stroke needs further research.