Association between stroke and psychosis across four nationally representative psychiatric epidemiological studies

Background Both stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has been under-researched. To date, there are no general population studies on their joint prevalence and association. Aims To estimate the joint prevalence of stroke and psychosis and their statistical association using nationally representative psychiatric epidemiology studies from two high-income countries – United Kingdom and the United States – and two middle-income countries – Chile and Colombia, and, subsequently, in a combined countries dataset. Methods Prevalences were calculated with 95% confidence intervals. Statistical association between stroke and psychosis, and stroke and psychotic symptoms, was tested using regression models. Overall estimates were calculated using an individual participant level meta-analysis on the combined countries dataset. The analysis is available online as a computational notebook. Results The overall prevalence of probable psychosis in stroke was 3.81% [95% CIs 2.34 - 5.82] and stroke in probable psychosis was at 3.15% [95% CIs 1.94 - 4.83]. The adjusted association between stroke and probable psychosis was OR = 3.32 [95% CIs 2.05 - 5.38]. On the individual symptom level, paranoia, hallucinated voices, and thought passivity delusion were associated with stroke in the unadjusted and adjusted analyses. Conclusions Rates of association between psychosis and stroke suggest there is likely a high clinical need group who are under-researched and may be poorly served by existing services. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study is a secondary analysis of existing datasets made public by the institutions that collected the data. The relevant ethical approvals are: Adult Psychiatric Morbidity Survey 2007 (UK) The Research Ethics Committee of the Royal Free Hospital and Medical School gave ethical approval for the original study. Collaborative Psychiatric Epidemiology Surveys 2001-2003 (US) The Institutional Review Board of the University of Michigan gave ethical approval for the original study. National Mental Health Survey 2015 (Colombia) The review boards of the the Pontificia Universidad Javeriana and Colciencias gave ethical approval for this study. National Health Survey 2016-2017 (Chile) The ethics committee of the Escuela de Medicina de la Pontificia Universidad Catolica de Chile have ethical approval for this study. Links to all datasets are listed on the github page of the present study: I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes This study is a secondary analysis of existing datasets and so produced no new raw data.