The association between self-perceived stress and ischemic stroke risk: a systematic review and meta-analysis

Background: An increasing body of research indicates that psychological stress is a contributing factor to stroke. Nonetheless, the correlations between self-perceived stress and stroke remain ambiguous. We performed the first meta-analysis on the correlation between self-perceived stress and stroke risk, establishing a clear relationship between self-perceived stress and stroke. Methods: Two reviewers independently searched electronic databases (MEDLINE, PubMed, Cochrane Library, Web of Science, and EMBASE database) for stroke and self-perceived stress studies. Studies employing the Perceived Stress Scale (PSS), Single question, or 2 single-item questions assessment tools were included, studies were executed and presented in English from inception to March 7, 2025. Eleven papers were included into this meta-analysis. Results: (1) In our meta-analysis, the multivariable-adjusted relative risk (RR) indicated that self-perceived stress was independently associated with stroke risk. (2) Subgroup analysis revealed that individuals with high self-perceived stress had a significantly elevated stroke risk, whereas no significant association was observed in those with low self-perceived stress. (3) Furthermore, our meta-analysis demonstrated that elevated self-perceived stress was associated with higher stroke mortality; (4) In sex-specific analysis, self-perceived stress was significantly associated with increased stroke risk in women, but not in men. Conclusion: Self-perceived stress was associated with increased stroke risk, especially in individuals reporting moderate-high self-perceived stress levels and women. Furthermore, elevated self-perceived stress was correlated with stroke mortality. Systematic review registration: PROSPERO, CRD420251026081.