Post-stroke depression and lesion location: a systematic review

Abstract

Post-stroke depression (PSD) is a frequent problem in stroke rehabilitation. Several studies have evaluated association between the lesion location and the risk of depression. Different conclusions and contradictory findings have been published. The aim of the present study was to perform a systematic meta-analysis to evaluate the relationship between PSD and lesion location. We researched PubMed, ISI Web of Science, EMBASE, and systematically reviewed available publications reporting investigations on stroke location and risk of PSD. Subgroup analyses were performed according to the time since stroke onset to assessment for PSD or the source of patients. Odds ratios (ORs) and 95 % confidence intervals (CIs) were used for pooled analyses. Heterogeneity was assessed with Cochran's Q test and I (2) test. Begg's funnel plot and Egger's test were used to examine the publication bias. A total of 43 studies involving 5,507 patients suffering from stroke were included in this meta-analysis. The pooled OR with 95 % CI for the overall association of stroke location and depression risk was 0.99 (0.88-1.11). Subgroups analyses highlighted that only studies with subacute post-stroke group (1-6 months) showed a statistical association between right hemisphere stroke and risk of depression (OR = 0.79, 95 % CI 0.66-0.93). This systematic review offered no support for the hypothesis that lesion of the left hemisphere was associated with an increased risk of depression after stroke. We only find significant association between right hemisphere stroke and incidence of depression for studies within subacute post-stroke phase.

The association between lesion location, sex and poststroke depression: Meta‐analysis

“…The phenomenology of PSD should be considered to be different from the noncomorbid depression. The measurement of PSD would take into account the impairments of function, cognition, and language that often accompany stroke (Bhogal et al., 2004; Wei et al., 2015). For example, stroke was considered to directly lead to the clinical symptoms of psychomotor retardation, fatigue, and sleep and appetite disturbances.…”

“…Growing evidence has indicated that different clinical PSD subtypes are classified according to the different time interval between the depression diagnosis and the stroke onset and may exist different pathological mechanisms (Wei et al., 2015). A large number of studies have reported that the time interval can influence the relationship between the occurrence of PSD and the location of brain stroke lesion.…”

“…Two meta‐analysis studies from either acute or chronic stroke patients have reported no significant association between PSD and lesion location (Ayerbe, Ayis, Wolfe, & Rudd, 2013; Kutlubaev & Hackett, 2014). However, a recent meta‐analysis showed that PSD has been associated right hemisphere lesion during 1–6 months after stroke (Wei et al., 2015). Our conclusion revealed that the occurrence of PSD is associated with left hemisphere lesions in subacute poststroke patients.…”

“…Second, we conducted subgroups analyses according to the timing of interview for PSD of the included studies. We named ≤1 month as acute poststroke phase, 1–6 months as subacute poststroke phase, and >6 months as chronic poststroke phase (Wei et al., 2015). According to the source of patients (clinic, rehabilitation center, and community), we also conducted a supplementary analysis.…”

“…Bhogal and colleagues conduct a systematic review and maintain that PSD is associated with the left brain hemispheric lesion after stroke onset (Bhogal, Teasell, Foley, & Speechley, 2004), while Yu and colleagues report a weak association between PSD and right brain hemispheric lesion after stroke onset (Yu et al., 2004). A recent systematic review suggests the association between PSD and lesion location is affected by stratification of time between stroke and the assessment of PSD, and finds a strong relationship between PSD and right brain hemispheric lesion within subacute poststroke phase (Wei et al., 2015). These variances in the association between PSD and lesion location can be explained by the mixed stroke type (Esparrago Llorca, Castilla‐Guerra, Fernandez Moreno, Ruiz Doblado, & Jimenez Hernandez, 2015; Tsai, Anderson, Thomas, & Sudlow, 2016, 2015) and stratification of gender (Poynter et al., 2009; Mackay & Mensah, 2004).…”