SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicReviews in Preventative Health for Stroke and Education to Stroke PreventionView all 16 articles
The correlation between perceived psychosocial stress and stroke: A meta-analysis
Provisionally accepted
- China-Japan Union Hospital, Jilin University, Changchun, China
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Objective:This meta-analysis aimed to evaluate the association between perceived psychosocial stress and stroke. Methods:We systematically searched PubMed, Web of Science, Embase and Cochrane Library until March 2025. Results:Eleven case-control studies were included, with the case group comprising stroke patients (n=21,024) and the control group consisting of healthy individuals matched for other characteristics (n=22,408). Meta-analysis revealed a higher incidence of perceived psychosocial stress in the stroke population compared to the control group (RR = 1.58, 95% CI [1.17-1.80], P < 0.00001, I² = 84%), with statistically significant differences. Subgroup analyses were conducted for regions: Europe and America (RR = 1.53, 95% CI [1.19-1.95], P = 0.0007); Asia (RR = 2.10, 95% CI [1.37-2.91], P = 0.0006); stroke types: ischemic stroke (RR = 1.58, 95% CI [1.30-1.91], P < 0.0001; hemorrhagic stroke (RR = 1.43, 95% CI [1.33-1.53], P < 0.00001); Sex: Male (RR = 1.58, 95% CI [1.44-1.73], P < 0.00001); Female (RR = 1.38, 95% CI [1.27-1.51], P < 0.00001); and Age <50 years (RR = 1.50, 95% CI [1.24-1.83], P < 0.0001).14 prospective cohort studies were included, with 107,741 participants in the perceived stress group and 69,784 in the control group. The results showed that the perceived stress group had a higher probability of stroke than the control group, but the difference was not statistically significant (RR = 1.29, 95% CI [0.83–2.02], P = 0.26, I² = 99%). Subgroup analyses for Europe and America (RR = 1.65, 95% CI [0.88–3.07],P = 0.12) and Asia (RR = 1.06, 95% CI [0.82–1.38], P = 0.64) also showed no statistically significant differences. No significant associations were found for ischemic stroke (RR = 0.94, 95% CI [0.75–1.17], P = 0.57), hemorrhagic stroke (RR = 0.97, 95% CI [0.73–1.29],P = 0.83), or by Sex (Male: RR = 1.95, 95% CI [0.87–4.36], P = 0.11; Female: RR = 0.59, 95% CI [0.18–1.96], P = 0.39). Conclusion:Meta-analysis of case-control studies demonstrated that perceived psychosocial stress is a risk factor for stroke, ischemic stroke, and hemorrhagic stroke in both Europe/America and Asia, regardless of sex, particularly among stroke patients Age< 50. Meta-analysis Registration:PROSPERO2025;https://www.crd.york.ac.uk/PROSPERO/view/ CRD420251012354.
Keywords: case-control study, Hemorrhagic, Ischemic, prospective cohort study, stress, Stroke
Received: 01 Jun 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Wang, Shi and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lei Xu
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