Post stroke depression, first year post stroke, in middle band patients

Abstract

Post Stroke Depression (PSD) is a frequent and treatable complication of stroke, with significant influence on recovery and mortality (De Weg et al., 1999) but its mechanism is not well understood. While there is some evidence for the organic base of PSD (Robinson et al., 1984), it may also represent an expected emotional reaction to the severe disability imposed by the stroke. The rate of post stroke depression varies according to the mode of assessment between 20% and 70% and therefore it is not clear whether it is higher or equal to the rate of depression found in patients inflicted with other serious medical conditions (Lieberman et al., 1999).The purpose of this study was to investigate the occurrence of PSD and the proportion of patients treated, in 'middle band' stroke patients, that is subjects who remained moderately but significantly impaired and disabled despite their returning to live in the community, during first year post-stroke. In order to investigate the causes of PSD we compared its connection with stroke characteristics and stroke-induced impairment to its connection with stroke-induced disability.Subject population included 65 consecutive middle band stroke patients, returning home, after in-patient rehabilitation. Depression was assessed using the short form of the Geriatric Depression Scale (GDS), 3 and 9 months post stroke (Burke et al., 1991). When 50% or more of relevant statements were positive it was assumed that the subject was suffering from PSD. GDS results were correlated to sociodemographic characteristics including perceived social support, assessed by the Tel Aviv social support scale. Stroke related characteristics and stroke related impairments were recorded and measured with the Fugl-Meyer Scale (FMS) and the Postural Assessment Scale (PASS). Disability and handicap were assessed using the Functional Independence Measure (FIM), Nottingham Extended ADL Index (NEADLI) and London Handicap Scale (LHS). Cognitive status was measured with the cognitive subscale of the FIM and the MMSE. RESULTSMean age was 72 AE 7, 63% male and 72% were married. All subjects were independent, pre stroke, in basic and advanced activities of daily life. Patients spent 45 AE 23 days in in-patient rehabilitation before returning home. At 3 months post stroke, mean GDS scores were 57% AE 26%, and 63% of patients answered positively to 50% or more of statements indicating depression; at 9 months the results were 53% AE 27% and 58% respectively. 28% of the patients received antidepressant medication and this was associated with an increased GDS score, but no relationship was found between taking antidepressants at 3 months post stroke and results of the GDS at 9 months. Higher level of perceived social support and lower level of education were significantly associated with a risk of developing PSD while other sociodemographic characteristics were not. Except for a significant relationship with cognitive measurements the occurrence of PSD was not associated with any of the evaluated stroke-related character...

Predictors of depressive symptoms in patients with stroke – a three-month follow-up

“…Patients with post-stroke depressive symptoms were more cognitively impaired. Our finding is in agreement with the results of many previous studies, where a correlation between PSD and cognitive impairment was found [2,3,11,17,20]. Contrary to previous studies [22,42,43], we did not observe differences between the number of aphasic patients in both groups, and we did not analyze the predictive value of aphasia for PSD.…”

“…High level of social functioning was related to lower risk for PSD in a previous study by Shimoda and Robinson [47]. Conversely, Gottlieb et al [2] observed that high rather than low level of social support was associated with PSD. It is difficult to properly define social support and its role in PSD.…”

“…Depressive symptoms are a common consequence of stroke. The prevalence of depression or depressive mood after stroke (post-stroke depression -PSD) has been reported to range from 25% to 79% [1][2][3], with a pooled estimate of 33% [4]. Although depression is recognized as an important complication of stroke, which worsens outcome and quality of life [5], there is uncertainty regarding its aetiology, risk factors and management [6].…”

Detection and treatment of post stroke depression: results from the registry of the Canadian stroke network

“…Numerous observational studies have examined the prevalence of PSD. The estimated prevalence of PSD in studies which employed screening of an entire stroke population have varied from 11% (House et al , 1991) to 63% (Gottlieb et al , 2002), with a mean prevalence of 19.3% for major depression, 18.5% for minor depression (Robinson, 2003) and an overall prevalence of any depressive disorder of 33% (Hackett and Anderson, 2005). What is not known is how commonly PSD is diagnosed and treated in actual clinical practice.…”

The relationship between mood state, interpersonal attitudes and psychological distress in stroke patients

“…On n'a constaté aucune influence é vidente de l'appré ciation de l'humour Introduction Persistent poststroke depression (PSD) presents a special challenge, often adversely influencing recovery and mortality (Gottlieb et al, 2002;Nicholl et al, 2002;Gokkaya et al, 2005) and interpersonal relationships (Mukherjee et al, 2006;Haun et al, 2008). Les contrô les de dé pression aprè s accident cardio-vasculaire (n = 30) et rhumatismaux/orthopé diques (n = 30) ont é té comparé s au niveau de l'effet de l'induction verbale et non verbale d'humeur positive et neutre sur l'é tat de l'humeur, les attitudes interpersonnelles, l'angoisse psychologique et les autres dé ficiences de traitement cognitif et é motionnel connexes.…”