Acute post stroke depression at a Primary Stroke Center in the Middle East

Abstract

ObjectiveDepression occurs in approximately 30 percent of stroke patients, leading to increased disability, lower quality of life and increased mortality. Given new recommendations to assess depression in acute stroke patients this study evaluated rates of acute post stroke depression at a Primary Stroke Center in Doha, Qatar.MethodsAcute stroke patients (n = 233) were given the PHQ-9 and the Mini-Cog test by stroke unit nurses within the first few days post stroke. This was part of a clinical improvement project conducted from March 2016 thru March 2017.ResultsApproximately 20% of acute post stroke patients (46/233) scored in the moderately depressed range on the Patient Health Questionnaire (PHQ-9 ≥10 with item 1 and/or 2 endorsed). Nationality and dysarthria were significantly associated with depression. Females were twice as likely to be depressed. A significantly greater number of Middle Eastern and African patients were depressed (30.18%) than Southeast Asian and Western Pacific patients (16.76%). A PHQ-2 cut off of 2 was optimal with sensitivity of 91.3 and specificity of 71.6.ConclusionsAlmost 20% of acute stroke patients were moderately depressed on the PHQ-9, with Middle Eastern/African patients almost twice as likely to be depressed. This may reflect higher baseline pre-stroke depression levels in those of Middle Eastern/African background, perhaps due to greater levels or stress or trauma exposure in these groups. Dysarthria was found to be significantly associated with depression. Initial screening with the PHQ-2 using a cut-off of 2 (versus the cut-off of 3 used in primary care settings) may be beneficial. Based on these results acute post stroke depression screening is recommended in the Middle East, coupled with culturally sensitive psychiatric care.

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

“…These included 18.8% (70/372) women and 8.1% (42/519) men. This supports a previous report from our center showing that female patients are more likely to have depression following AS in Qatar [22] (Table 2).…”

Clinical Risk Factors that Predict Functional Recovery in Ischemic Stroke Patients with Pre-Stroke Depression

“…The association between antihypertensive medication and depression is well documented in the literature [32,33]. It is known that if depression occurs prior to stroke, medication use plays a role in the treatment outcome of the stroke [21,34]. It is also known that clinical risk factors contribute to, or worsen, the underlying disease such as depression and stroke [28].…”

“…While post-stroke depression is a common occurrence and linked with poor outcome [16][17][18][19], the effect of pre-stroke depression on treatment outcome in ischemic stroke patients is not well understood. Pre-stroke depression may be associated with abnormal modification of risk factors in ischemic stroke [20,21], and may affect functional ambulatory outcome following rtPA.…”

Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

“…The association between antihypertensive medication and depression is well documented in the literature [32,33]. It is known that if depression occurs prior to stroke, medication use plays a role in the treatment outcome of the stroke [21,34]. It is also known that clinical risk factors contribute to, or worsen, the underlying disease such as depression and stroke [28].…”