Global divergence of stroke and major depressive disorder: unveiling a potential “hidden stagnation” pattern through an integrated medicine perspective
- 1Henan University of Chinese Medicine, China
- 2The First Affiliated Hospital of Xinxiang Medical University, China
Abstract
Background: Major 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.
Methods: Using 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.
Results: A negative ecological correlation emerged globally and strengthened over time (r = −0.059 in 1990 versus r = −0.218 in 2023, P = 0.002). The highest stroke burden quartile (Q4) reported lower MDD prevalence (2639.9/100 000) than the lowest quartile (3067.0/100 000; mean difference 427.1/100 000, 95% CI: 121.52 to 732.58), despite an 8.3% increase in stroke burden in Q4. The score identified clusters with disproportionate stroke burden relative to MDD prevalence in Eastern Europe, Southeast Asia, and Pacific Island settings.
Conclusions: Low 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.
Related
- Major Depressive Disorder With Non-Suicidal Self-Injury in Adolescents: Altered Morphological Inverse Divergence Gradient in Brain Structure and Gene Expression Patterns.
- Sarcopenia and Muscle Dysfunction in Older Adults with Burn Injuries: An Integrated Clinical Perspective
- Integrated time-series multi-omics reveals temporal reprogramming and inter-organ divergence in diabetic cardiorenal syndrome
- Assessing policy element coverage in local plans for tightly integrated urban medical groups in China: an integrated care perspective
- Optimizing physician-patient communication through an integrated perspective of prospect theory and the ultimatum game: a controlled study among patients undergoing elective surgery or invasive procedures in a Chinese tertiary hospital
BibTeX
@article{jia2026global,
title = {{Global divergence of stroke and major depressive disorder: unveiling a potential “hidden stagnation” pattern through an integrated medicine perspective}},
author = {Kui Jia and Ling-Ling Qian and Fu-Cheng Zhao and Qian Sun and Meng-Meng Zhang and Yi-Fan Li},
journal = {CNS Spectrums},
year = {2026},
month = oct,
doi = {10.1017/s1092852926101266},
url = {https://doi.org/10.1017/s1092852926101266},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Global divergence of stroke and major depressive disorder: unveiling a potential “hidden stagnation” pattern through an integrated medicine perspective
AU - Kui Jia
AU - Ling-Ling Qian
AU - Fu-Cheng Zhao
AU - Qian Sun
AU - Meng-Meng Zhang
AU - Yi-Fan Li
PY - 2026
DA - 2026/10/29
JO - CNS Spectrums
DO - 10.1017/s1092852926101266
UR - https://doi.org/10.1017/s1092852926101266
AB - Background: Major 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. Methods: Using 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. Results: A negative ecological correlation emerged globally and strengthened over time (r = −0.059 in 1990 versus r = −0.218 in 2023, P = 0.002). The highest stroke burden quartile (Q4) reported lower MDD prevalence (2639.9/100 000) than the lowest quartile (3067.0/100 000; mean difference 427.1/100 000, 95% CI: 121.52 to 732.58), despite an 8.3% increase in stroke burden in Q4. The score identified clusters with disproportionate stroke burden relative to MDD prevalence in Eastern Europe, Southeast Asia, and Pacific Island settings. Conclusions: Low 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.
SN - 1092-8529
SN - 2165-6509
ER -