BMC neurology
Psychosocial stress and risk of first-ever stroke: a systematic review and meta-analysis
By Khalifa MA, Hassanein D, Alsabbagh AAI and 13 others.
Abstract
Background
Psychosocial stress has been recognized as a potential risk factor for stroke; however, the strength and consistency of its association with first-ever stroke remain uncertain. This systematic review and meta-analysis aimed to determine the overall association between psychosocial stress and the risk of first stroke in a stroke-free population.
Methods
We conducted a systematic review and meta-analysis in accordance with the PRISMA and MOOSE guidelines. PubMed, Scopus, Web of Science, and Ovid were searched from inception to 1 January 2026 for cohort or case-control studies. Eligible studies enrolled participants without a prior history of stroke and reported adjusted risk estimates with 95% confidence intervals. Psychosocial stressors were categorized into psychological, vocational, interpersonal, and behavioral domains. Stroke outcomes included ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, transient ischemic attack, and unspecified stroke.