Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence

Chun, Ho-Yan Yvonne; Ford, Andrew H.; Kutlubaev, Mansur A.; Almeida, Osvaldo P.; Mead, Gillian

doi:10.1161/strokeaha.121.035499

Cited by 47 publications

(37 citation statements)

References 108 publications

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“…Stroke severity, physical disability, history of depression, and cognitive impairment have been the most well-recognized predictors of PSD ( Towfighi et al, 2017 ). Sex, age, education level, social support, and personality traits (e.g., neuroticism) are also considered potential (although less clear) predictors of PSD ( Towfighi et al, 2017 ; Chun et al, 2021 ). A previous study found that both functional dependence and neuroanatomical measures were correlated with more PSD symptoms ( Singh et al, 2000 ).…”

Section: Discussion: Future Directions and Clinical Implicationsmentioning

confidence: 99%

“…Some aspects in DSM-5 criteria, such as “disturbance is the direct pathophysiological consequence of another medical condition,” are almost impossible to prove in clinical practice ( American Psychiatric Association, 2013 ). Therefore, the diagnosis of PSD relies on a thorough clinical interview with careful exploration of presenting symptoms and is commonly assisted by the use of screening tools (specifically the depression rating scales validated in PSD screening) ( Chun et al, 2021 ). Although multiple depression scales have been applied and compared in previous studies, the optimal screening tool for PSD remains undetermined ( Towfighi et al, 2017 ).…”

Section: Definition Diagnosis and Measurement Of Poststroke Depressionmentioning

confidence: 99%

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Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends

Pan

Sun

et al. 2022

Front. Neurosci.

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Poststroke depression (PSD), affecting about one-third of stroke survivors, exerts significant impact on patients’ functional outcome and mortality. Great efforts have been made since the 1970s to unravel the neuroanatomical substrate and the brain-behavior mechanism of PSD. Thanks to advances in neuroimaging and computational neuroscience in the past two decades, new techniques for uncovering the neural basis of symptoms or behavioral deficits caused by focal brain damage have been emerging. From the time of lesion analysis to the era of brain networks, our knowledge and understanding of the neural substrates for PSD are increasing. Pooled evidence from traditional lesion analysis, univariate or multivariate lesion-symptom mapping, regional structural and functional analyses, direct or indirect connectome analysis, and neuromodulation clinical trials for PSD, to some extent, echoes the frontal-limbic theory of depression. The neural substrates of PSD may be used for risk stratification and personalized therapeutic target identification in the future. In this review, we provide an update on the recent advances about the neural basis of PSD with the clinical implications and trends of methodology as the main features of interest.

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Section: Discussion: Future Directions and Clinical Implicationsmentioning

confidence: 99%

Section: Definition Diagnosis and Measurement Of Poststroke Depressionmentioning

confidence: 99%

Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends

Pan

Sun

et al. 2022

Front. Neurosci.

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“…The study outcome was depression evaluated using the 17-item Hamilton depression scale (HAMD-17) 14-21 days after stroke onset [3,29]. HAMD-17 has been translated into Chinese.…”

Section: Assessment Of Malnutrition and Post-stroke Depressionmentioning

confidence: 99%

“…Depression is common after stroke. A meta-analysis published in 2005 reported a pooled prevalence of 33% and prevalence ranging from 14% to 41% [2][3][4]. Poststroke depression (PSD) has a negative impact on cognitive recovery, functional outcomes, and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke

Hua

Tang

et al. 2022

Nutrients

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Background: Malnutrition is associated with poor outcomes after stroke. However, the association between malnutrition and post-stroke depression (PSD) remains unelucidated. We aimed to explore the association between geriatric nutritional risk index (GNRI) and depression after ischemic stroke. Methods: In total, 344 patients with ischemic stroke were included in this analysis. The GNRI was calculated from serum albumin level, weight, and height at admission. Malnutrition was defined using the GNRI cutoff points. A lower GNRI score indicates an elevated nutritional risk. The outcome was depression, measured 14 days after ischemic stroke. Logistic regression models were used to estimate the association between the GNRI and risk of PSD. Results: A total of 22.9% developed PSD 14 days after stroke. The mean GNRI was 99.3 ± 6.0, and 53.8% of the patients had malnutrition. After adjusting for covariates, baseline malnutrition was not associated with risk of PSD (OR, 0.670; 95%CI, 0.370–1.213; p = 0.186). The restricted cubic splines revealed a U-shaped association between the GNRI and PSD. Compared to moderate GNRI, higher GNRI (OR, 2.368; 95%CI, 0.983–5.701; p = 0.085) or lower GNRI (OR, 2.226; 95%CI, 0.890–5.563; p = 0.087) did not significantly increase the risk of PSD. Conclusion: A low GNRI was not associated with an increased risk of depression after ischemic stroke.

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“… 1–3 According to a new review, PSD incidence was highest especially within 3 months after the acute event and the cumulative incidence of PSD was up to 52% within 5 years of stroke. 4 There are many hypotheses about the pathogenesis of PSD, but the biological mechanisms remain unclear. Neuroendocrine disorders, 5 , 6 especially hypothalamic-pituitary-adrenal (HPA) axis dysfunction, 7 which is considered as a potential pathogenesis of PSD, has been aroused the concern of researchers and become a hot topic in recent years.…”

Section: Introductionmentioning

confidence: 99%

Higher Concentration of Adrenocorticotropic Hormone Predicts Post-Stroke Depression

Wang¹,

Wang²,

Sun³

et al. 2022

CIA

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Background Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, seriously affecting the quality of survivors’ life. As one of the important causes of PSD, neuroendocrine mechanism has been widely studied in recent years. The main objective of this study was to investigate the relationship between adrenocorticotropic hormone (ACTH) on admission and PSD at 3 months. Methods This is a hospital-based prospective cohort study, which was conducted at three independent hospitals (Tongji Hospital, Wuhan First Hospital and Wuhan Central Hospital) between August 2018 and June 2019. A total of 768 ischemic stroke patients were finally eligible for analysis and categorized into equal tertiles according to the distribution of ACTH and the number of patients. The χ 2 -test, Mann–Whitney U -test and Kruskal–Wallis test were used to check for statistical significance. And restricted cubic spline (RCS) regression model was used to explore the non-linear relationship between continuous ACTH levels and PSD at 3 months. Results The optimal cut-off points of ACTH were as follows: (T1) 0.32–20.55 pg/mL, (T2) 20.56–39.79 pg/mL, (T3) 39.80–143.40 pg/mL. A total of 305 patients (39.7%) were diagnosed as PSD at 3 months follow-up. Significant differences were found between the PSD and non-PSD groups in ACTH concentration (P = 0.001). After adjustment for all conventional confounders, the odds ratios of PSD were 1.735 (95% CI = 1.176–2.560, P = 0.005) for the highest tertile of ACTH and 1.496 (95% CI = 1.019–2.194, P = 0.040) for the middle tertile of ACTH, as compared with the lowest tertile. In multiple-adjusted RCS regression, continuous ACTH showed saturation effect relation with PSD risk after 31.02 pg/mL (P for nonlinear = 0.0143). Conclusion Higher ACTH level on admission is a significant and independent biomarker to predict the development of PSD at 3 months follow-up. Besides, saturation effect was revealed even if the underlying mechanism is unclear. For stroke patients, doctors should pay attention to the baseline ACTH for screening high-risk PSD in clinical practice.

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Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence

Cited by 47 publications

References 108 publications

Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends

Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends

Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke

Higher Concentration of Adrenocorticotropic Hormone Predicts Post-Stroke Depression

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