Background
The influence of poststroke depression on long-term survival is poorly investigated.
Thus, we aimed to evaluate the influence of major depression disorder (MDD) on long-term
survival in the participants from The Study of Stroke Mortality and Morbidity in Adults
(EMMA Study) in São Paulo, Brazil.
Methods
We prospectively evaluated ischemic and hemorrhagic stroke (HS) cases from the EMMA
Study. Baseline and stroke characteristics and cardiovascular risk factors were evaluated
according to MDD assessed by the Patient Health Questionnaire, which was applied 30
days after index event and periodically during 1-year follow-up. We performed Kaplan–Meier
survival analysis, as well as crude and multiple Cox proportional hazards models.
Results
In this subset of the EMMA Study, we evaluated 164 (85.9%) patients with ischemic
stroke and 27 (14.1%) with HS. Among these, overall incidence of MDD was 25.1% during
1 year of follow-up, regardless stroke subtype. The peak rate of major depression
postacute event was beyond 1 month. We observed a lower survival rate among individuals
who developed poststroke MDD than among those who did not develop this condition after
1 year of follow-up (85.4% versus 96.5%, log rank P = .006). After multiple analysis, we kept a higher risk of all-cause mortality among
those who developed MDD compared to participants without MDD (hazard ratio = 4.60,
95% confidence interval = 1.36-15.55, P = .01).
Conclusion
Our findings suggest that incident MDD is a potential marker of poor prognosis 1 year
after stroke.
Key Words
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Article info
Publication history
Published online: December 24, 2015
Accepted:
November 22,
2015
Received in revised form:
October 16,
2015
Received:
July 15,
2015
Footnotes
Authors' contributions: Roberta F. Mello, Dr. Itamar S. Santos, and Dr. Isabela M. Benseñor—study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content including drafting/revising the manuscript, medical writing for content, and final approval of the version to be published. Dr. Airlane P. Alencar—analysis and interpretation, critical revision of the manuscript for important intellectual content including drafting/revising the manuscript, medical writing, and final approval of the version to be published. Dr. Paulo A. Lotufo—study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content, including drafting/revising the manuscript, medical writing for content, and final approval of the version to be published. Dr. Alessandra C. Goulart—study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, including drafting/revising the manuscript, medical writing for content, study supervision, and final approval of the version to be published.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.021
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
