Prevalence and predictors of new onset depression in the acute phase of stroke

Isuru, Amila; Hapangama, A.; Ediriweera, Dileepa Senajith; Samarasinghe, Lochana; Fonseka, Madhavi; Ranawaka, Udaya K.

doi:10.1016/j.ajp.2021.102636

Cited by 18 publications

(12 citation statements)

References 31 publications

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“…An earlier study done in Sri Lanka in a similar setting revealed a prevalence of PSD 28% similar to our study. 34 They found that female gender, duration of pre-existent hypertension, Barthel index (degree of disability), and temporal lobe involvement were independently associated with PSD. The main methodological differences in this study were: depression was assessed within one month of stroke, depression was diagnosed by a single psychiatrist based on the ICD-10 criteria, and patients with both ischemic and hemorrhagic strokes were included.…”

Section: Discussionmentioning

confidence: 98%

Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka

Thambirajah¹,

Senanayake

Gooneratne

et al. 2022

JNRP

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Background and Objectives The prevalence of stroke in urban Sri Lanka is estimated at 10.4 per 1000 and is expected to rise. Post-stroke depression (PSD) is an independent predictor of poor long-term outcomes. It leads to suboptimal rehabilitation, decreased quality of life, and increased mortality and is under-recognized. The main objectives of this study were to estimate the prevalence of depression in stroke, assess factors associated with PSD, and assess the relationship of PSD to disability. Materials and Methods A descriptive cross-sectional study was conducted at the Neurology and Medical Ward, National Hospital of Sri Lanka. Non-probability, consecutive sampling was used to collect data from patients with ischemic stroke admitted from January 2019 to January 2020. Patients with significant pre-existing depression, cognitive impairment, and language deficits were excluded. A structured, pre-tested interviewer-administered questionnaire was used to assess the prevalence and associated factors of PSD. Beck's Depression Inventory (BDI) was administered 3 months following the stroke to screen for depression. Modified Rankin Score (MRS) was used to assess disability on admission, discharge, and at 3 months. Results Eighty-one stroke patients were screened. The mean age was 66.6 years (±standard deviation [SD]: 12.5). Male:female ratio was 1.2:1. Depression at 3 months of follow-up was observed in 35.8% (95% confidence interval [CI]: 25.4–47.2%) of participants. Following bivariate analysis, large vessel stroke (p < 0.001), cortical stroke (p < 0.001), frontal lobe lesions (p < 0.001), history of past stroke (p = 0.014), and sexual dysfunction (p = 0.026) were associated with increased risk of PSD. The odds of a person with severe disability developing PSD was 7.9 times more than a person with a less severe disability at discharge from hospital and at 3 months of follow-up (odds ratio [OR] =7.9; 95% CI: 2.7–23.3, p = 0.000). Conclusions PSD occurs in one-third of strokes, keeping with previous studies. The risk of having PSD is higher among patients with severe disabilities. The difference in risk factors identified compared with previous studies can be attributable to differences in methodology. Identifying risk factors for post-stroke depression is essential to mitigate the poor outcome.

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Section: Discussionmentioning

confidence: 98%

Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka

Thambirajah¹,

Senanayake

Gooneratne

et al. 2022

JNRP

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“…Given that only a small percentage of stroke patients arrive at the hospital within hours, PSD and PSA in the acute phase of stroke are independent predictors of poor functional outcomes. [4][5][6][7][8][9] Because of slow onset, 11 SSRIs are not suitable for the management of depression and anxiety symptoms in the acute phase of stroke. Positive allosteric modulators of GABA A Rs have been used in the management of depression and anxiety disorders.…”

Section: Discussionmentioning

confidence: 99%

“…3 Moreover, poststroke depression (PSD) and anxiety (PSA) are very common, and constitute an independent predictor of poor functional outcomes and quality of life during both the acute and chronic phases. [4][5][6][7][8][9] Unfortunately, high-quality clinical evidence shows that selective serotonin reuptake inhibitors (SSRIs), first-line options for pharmacological management of depression and anxiety disorders, do not reduce disability after stroke and cause a slightly increased risk of seizures and fractures, although they reduce the risk of future depression by about a quarter. 10 Additionally, because of slow onset, 11 SSRIs are not suitable for the management of depression and anxiety symptoms in the acute phase of stroke.…”

Section: Introductionmentioning

confidence: 99%

Preclinical evaluation of ZL006-05, a new antistroke drug with fast-onset antidepressant and anxiolytic effects

Huang

Wang

et al. 2023

Stroke Vasc Neurol

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BackgroundPoststroke depression and anxiety, independent predictor of poor functional outcomes, are common in the acute phase of stroke. Up to now, there is no fast-onset antidepressive and anxiolytic agents suitable for the management of acute stroke. ZL006-05, a dual-target analgesic we developed, dissociates nitric oxide synthase from postsynaptic density-95 while potentiates α2-containing γ-aminobutyric acid type A receptor. This study aims to determine whether ZL006-05 can be used as an antistroke agent with fast-onset antidepressant and anxiolytic effects.MethodsPhotothrombotic stroke and transient middle cerebral artery occlusion were induced in rats and mice. Infarct size was measured by TTC(2,3,5-Triphenyltetrazolium chloride) staining or Nissl staining. Neurological defects were assessed by four-point scale neurological score or modified Neurological Severity Scores. Grid-walking, cylinder and modified adhesive removal tasks were conducted to assess sensorimotor functions. Spatial learning was assessed using Morris water maze task. Depression and anxiety were induced by unpredictable chronic mild stress. Depressive behaviours were assessed by tail suspension, forced swim and sucrose preference tests. Anxiety behaviours were assessed by novelty-suppressed feeding and elevated plus maze tests. Pharmacokinetics, toxicokinetics and long-term toxicity studies were performed in rats.ResultsAdministration of ZL006-05 in the acute phase of stroke attenuated transient and permanent ischaemic injury and ameliorated long-term functional impairments significantly, with a treatment window of 12 hours after ischemia, and reduced plasminogen activato-induced haemorrhagic transformation. ZL006-05 produced fast-onset antidepressant and anxiolytic effects with onset latency of 1 hour in the normal and CMS mice, had antidepressant and anxiolytic effects in stroke mice. ZL006-05 crossed the blood–brain barrier and distributed into the brain rapidly, and had a high safety profile in toxicokinetics and long-term toxicological studies.ConclusionZL006-05 is a new neuroprotectant with fast-onset antidepressant and anxiolytic effects and has translational properties in terms of efficacy, safety and targeting of clinical issues.

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“…This study also found a high prevalence of PSD in the acute phase, which is similar to that in other studies. 32 , 33 Of first-ever stroke survivors, 32.9% developed depression at acute hospitalization that needed attention. This study indicated that the risk of PSD is gradually reduced from acute hospitalization to 6 months post-discharge.…”

Section: Discussionmentioning

confidence: 99%

Family Functioning is Associated with Post-Stroke Depression in First-Ever Stroke Survivors: A Longitudinal Study

Wang

Lin

et al. 2022

NDT

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Background: Post-stroke depression (PSD) can aggravate the mortality and recurrence rate in stroke patients. The relationship between family functioning and PSD at different phases after a first-ever stroke is unclear. The purpose of this longitudinal study was to investigate the patterns and relationship of family functioning and PSD at acute hospitalization and 6 months post-discharge in firstever stroke survivors. Methods: This is a longitudinal study conducted in Guangzhou, China. Family functioning and depression were measured by the Short Form Family Assessment Device (SF-FAD) and Self-Rating Depression Scale (SDS) at baseline and 6 months post-discharge. Multiple linear regression analysis was used to explore the relationship between family functioning and PSD. Results: The prevalence of PSD at acute hospitalization and 6 months post-discharge was 32.9% and 20.0%, respectively. SDS scores decreased significantly from baseline to 6 months post-discharge, while SF-FAD scores did not change significantly during this period. The Pearson correlation coefficient showed that SF-FAD scores were positively associated with SDS scores at the two time points (r 1 = 0.341, r 2 = 0.510, P < 0.05). Multiple linear regression analyses indicated that SF-FAD scores could predict PSD at baseline (unstandardized coefficient: 7.010, P < 0.05) and 6 months post-discharge (unstandardized coefficient: 9.672, P < 0.001). Conclusion:This study found that first-ever stroke survivors had good family functioning at baseline and 6 months post-discharge. The findings in this study verified that poor family functioning is positively associated with PSD at different phases post-stroke. Good family functioning is an important protective factor against PSD.

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Prevalence and predictors of new onset depression in the acute phase of stroke

Cited by 18 publications

References 31 publications

Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka

Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka

Preclinical evaluation of ZL006-05, a new antistroke drug with fast-onset antidepressant and anxiolytic effects

Family Functioning is Associated with Post-Stroke Depression in First-Ever Stroke Survivors: A Longitudinal Study

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