Abstract
Background
Poststroke depression (PSD) affects one-third of stroke patients and is linked with
higher stroke morbidity, mortality, and recurrence. Current guidelines do not direct
when to screen for PSD, and predictors of PSD are not well understood. We sought to
understand progression of PSD symptoms early after ischemic stroke, identify predictors
of PSD, and describe the use of antidepressants in PSD.
Methods
We collected demographic, clinical, and PSD (Patient Health Questionnaire-9; PHQ-9)
data from ischemic stroke patients hospitalized at our Comprehensive Stroke Center
and followed up in our clinic. PHQ-9 was obtained during hospitalization and again
in clinic within 180 days of discharge. We performed univariate analysis and logistic
regression to detect variables associated with PSD.
Results
Among 201 patients, PSD symptoms (PHQ-9 > 4) were identified in 30% of patients during
hospitalization and 46% during follow-up (54% of which had no symptoms during hospitalization).
At follow-up, 36% were worse by PHQ-9 category. In univariate analysis, follow-up
modified Rankin Scale (mRS) greater than or equal to 2 (P = .03) and antidepressant prescription (P < .001) were associated with worsening PHQ-9 category. In logistic regression analysis,
follow-up mRS greater than or equal to 2 (P = .02), posterior circulation stroke (P = .03), and antidepressant prescription (P < .01) were associated with worsening PHQ-9 category.
Conclusions
Almost half of ischemic stroke patients develop PSD symptoms and more than one-third
worsen between hospitalization and follow-up. Poststroke disability (mRS ≥ 2) and
posterior circulation stroke were associated with worsening PSD. Worsening PSD symptoms
prompted treatment change in 29% of patients. Screening for PSD during hospitalization
should be repeated during early follow-up.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics—2017 Update.2017https://doi.org/10.1161/CIR.0000000000000485
- The influence of gender and age on disability following ischemic stroke: the Framingham study.J Stroke Cerebrovasc Dis. 2003; 12: 119-126https://doi.org/10.1016/S1052-3057(03)00042-9
- The natural history of depression up to 15 years after stroke: the South London Stroke Register.Stroke. 2013; 44: 1105-1110https://doi.org/10.1161/STROKEAHA.111.679340
- Mood after stroke: a case control study of biochemical, neuro-imaging and socio-economic risk factors for major depression in stroke survivors.BMC Neurol. 2010; 10: 125https://doi.org/10.1186/1471-2377-10-125
- The associationbetween depression, suicidal ideation, and stroke in a population-based sample.Int J Stroke Off J Int Stroke Soc. 2012; 7: 188-194https://doi.org/10.1111/j.1747-4949.2011.00702.x
- A one-year follow-up study into the course of depression after stroke.J Nutr Health Aging. 2010; 14: 488-493
- Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis.Br J Psychiatry J Ment Sci. 2013; 202: 14-21https://doi.org/10.1192/bjp.bp.111.107664
- The Italian multicenter observational study on post-stroke depression (DESTRO).J Neurol. 2006; 253: 556-562https://doi.org/10.1007/s00415-006-0058-6
- The Clinical Neuropsychiatry of Stroke: Cognitive, Behavioral and Emotional Disorders following Vascular Brain Injury.2nd ed. Cambridge University Press, New York2006
- Depression is an independent predictor of poor long‐term functional outcome post‐stroke.Eur J Neurol. 2001; 8: 315-319https://doi.org/10.1046/j.1468-1331.2001.00182.x
- Risk factors for poststroke depression: identification of inconsistencies based on a systematic review.J Geriatr Psychiatry Neurol. 2014; 27: 147-158https://doi.org/10.1177/0891988714527514
- Predictors of depression after stroke: a systematic review of observational studies.Stroke. 2005; 36: 2296-2301https://doi.org/10.1161/01.STR.0000183622.75135.a4
- The factors related to early-onset depression after first stroke.Psychogeriatrics. 2017; : 414-422https://doi.org/10.1111/psyg.12266
- Mood changes in stroke patients: Relationship to lesion location.Compr Psychiatry. 1983; 24: 555-566https://doi.org/10.1016/0010-440X(83)90024-X
- Relationship between post-stroke depression and lesion location: a meta-analysis.Kaohsiung J Med Sci. 2004; 20: 372-380https://doi.org/10.1016/S1607-551X(09)70173-1
- Post-stroke depression and lesion location: a systematic review.J Neurol. 2015; 262: 81-90https://doi.org/10.1007/s00415-014-7534-1
- Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis.J Gen Intern Med. 2007; 22: 1596-1602https://doi.org/10.1007/s11606-007-0333-y
- Performance of the PHQ-9 as a screening tool for depression after stroke.Stroke. 2005; 36: 635-638https://doi.org/10.1161/01.STR.0000155688.18207.33
- Early depression screening is feasible in hospitalized stroke patients.PLoS One. 2015; 10e0128246https://doi.org/10.1371/journal.pone.0128246
- Does care in a specialised stroke prevention clinic improve poststroke blood pressure control: a protocol for a randomised comparative effectiveness study.BMJ Open. 2019; 9e024695https://doi.org/10.1136/bmjopen-2018-024695
- Depression and its relation to lesion location after stroke.J Neurol Neurosurg Psychiatry. 1998; 64: 371-374https://doi.org/10.1136/jnnp.64.3.371
- Depressive disorders in long-term survivors of stroke. Associations with demographic and social factors, functional status, and brain lesion volume.Br J Psychiatry. 1994; 164: 380https://doi.org/10.1192/bjp.164.3.380
- The relationship between frontal lobe lesions, course of post-stroke depression, and 1-year prognosis in patients with first-ever ischemic stroke.PLoS One. 2014; 9https://doi.org/10.1371/journal.pone.0100456
- Mood disorders in stroke patients. Importance of location of lesion.Brain J Neurol. 1984; 107: 81-93https://doi.org/10.1093/brain/107.1.81
- Baseline NIH Stroke Scale score strongly predicts outcome after stroke.Neurology. 1999; 53: 126https://doi.org/10.1212/WNL.53.1.126
- The PHQ-9: a new depression diagnostic and severity measure.Psychiatr Ann. 2002; 32: 509-521https://doi.org/10.3928/0048-5713-20020901-06
- Screening for poststroke major depression: a meta-analysis of diagnostic validity studies.J Neurol Neurosurg Psychiatry. 2014; 85: 198-206https://doi.org/10.1136/jnnp-2012-304194
- Poststroke depression: a scientific statement for health professionals from the American Heart Association/American Stroke Association.Stroke. 2017; 48: 30-43https://doi.org/10.1161/STR.0000000000000113
- Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial.Lancet Neurol. 2011; 10: 123-130https://doi.org/10.1016/S1474-4422(10)70314-8
- Frequency of depression after stroke.Stroke. 2005; 36: 1330-1340https://doi.org/10.1161/01.STR.0000165928.19135.35
- Natural history, predictors and associated outcomes of anxiety up to 10 years after stroke: the South London Stroke Register.Age Ageing. 2014; 43: 542-547https://doi.org/10.1093/ageing/aft208
- Distribution of symptoms of post-stroke depression in relation to some characteristics of the vulnerable patients in socio-cultural context.Afr Health Sci. 2017; 17: 70-78https://doi.org/10.4314/ahs.v17i1.10
- Age, subjective stress, and depression after ischemic stroke.J Behav Med. 2016; 39: 55-64https://doi.org/10.1007/s10865-015-9663-0
- Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis.Stroke. 2007; 38: 1091-1096https://doi.org/10.1161/01.STR.0000258355.23810.c6
- The impact of pre-stroke depressive symptoms, fatalism, and social support on disability after stroke.J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2017; 26: 2686-2691https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.039
- Depressive symptoms in stroke patients: a 13 month follow-up study of patients referred to a rehabilitation unit.J Affect Disord. 2010; 127: 211-218https://doi.org/10.1016/j.jad.2010.05.025
- Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics.J Neurol Sci. 2005; 228: 27-33https://doi.org/10.1016/j.jns.2004.09.031
Article info
Publication history
Published online: January 13, 2020
Accepted:
November 21,
2019
Received in revised form:
October 28,
2019
Received:
June 7,
2019
Footnotes
Grant Support: Dr. Fournier was supported by the following National Institutes of Health grant: 5T32NS007412-20.
This work was conducted at The Institute for Stroke and Cerebrovascular Diseases and The Department of Neurology at The University of Texas Health Science Center at Houston.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104561
Copyright
© 2019 Elsevier Inc. All rights reserved.
