Predictors of Depression after Stroke

Abstract

Background and Purpose-Although depression is common after stroke, there is uncertainty over its etiology and risk factors, which complicates management. Knowledge of the predictors of depression associated with stroke may allow for the better targeting of therapy, both prevention and treatment. Methods-We undertook a systematic review of all published, nonexperimental, population-, hospital-, and rehabilitationbased stroke studies (to June 2004) with prospective, consecutive patient recruitment undertaken to identify variables associated with depressive symptoms (or "illness") after stroke. Assessments were made of the quality of studies including the validity of prognostic models. Results-Data were available from 3 population-based studies including 492 patients, 8 hospital-based studies including 15 272 patients, and 9 rehabilitation-based studies including 2170 patients. Physical disability, stroke severity and cognitive impairment were consistently associated with depression. In addition to the common problem of selection bias, major limitations of these studies included variable selection and poor statistical quality and reporting; small sample sizes meant that only a limited range of variables were analyzed in multivariate models. Conclusions-There is a paucity of well-designed studies of sufficient size to allow stable multivariate predictive models of depression after stroke to be developed. Other than showing that depression is associated with more severe strokes, current evidence does not allow for ready identification of patients most at risk of developing this important complication of stroke.

Neuropsychiatric outcomes of stroke

“…17,19 One systematic review of observational studies of depression after stroke (20 cohorts, n=17,934) indicates that only physical disability, stroke severity and cognitive impairment consistently show a positive association with depression (note that most included studies excluded people with pre-stroke depression). 20 A second independent review using different methods included 10 cohorts (n=16,045) 13 and identified pre-stroke depression as being associated with subsequent depression after stroke, in addition to disability, stroke severity, cognitive impairment. Variables not associated with depression include older age, being Printed 27 Sep 2013 female, having diabetes, stroke subtype, level of education, living alone or previous stroke.…”

“…Variables not associated with depression include older age, being Printed 27 Sep 2013 female, having diabetes, stroke subtype, level of education, living alone or previous stroke. 20 Only one cohort was included in both reviews. Only a small proportion of the variation in depression was accounted for, though the included studies generally had sample sizes which were too small for multivariate analyses.…”

Post-stroke depression

“…Saját vizsgálataink során sem az akut, sem pedig a krónikus betegcsoportban nem láttunk összefüggést a laesio lokalizációja és a depresszív tünetek jelenléte között [26,27,28]. Carson [37], majd később Hackett [38] a korábbi közlemények elemzéseként arra a következtetésre jutott, hogy egyértelműen egyik féltekéhez és egyik struktúrához sem köthető a PSD kialakulása.…”

Afasia y depresión post-ictus: una relación predictiva

“…Hackett y Anderson demostraron en una revisión sistemática, que la depresión es la complicación neuropsiquiátrica más común (incidencia global del 33%) y que está asociada a un pronóstico peor 1 . Kouwenhoven et al demuestra una correlación entre síntomas depresivos y la mortalidad entre los 12 y 24 meses 2 .…”

“…Para hacer esto, el conocimiento de los factores predictores es esencial. En la revisión sistemá-tica más reciente que encontramos, los únicos predictores que alcanzaron significación estadística para la DPI fueron la gravedad del ictus, el grado de discapacidad del paciente y el déficit cognitivo 1 . Los problemas metodológicos impidieron la determinación de otros predictores.…”