Abstract
BackgroundDepression after stroke is common and is associated with poorer recovery. Risk factors such as gender, age and stroke severity are established, but it is unclear whether factors from earlier in life might also contribute.MethodsWe searched MEDLINE, PsycINFO, EMBASE and meta-analysed all available evidence on childhood (premorbid) IQ, socioeconomic status (SES), education and stroke in adulthood. We included all studies reporting data on >50 patients, calculating overall odds ratios (OR), mean difference, correlation, 95% confidence intervals (CI) and 95% predictive intervals (PI) using random effects methods. We quality assessed all studies, performed sensitivity analyses, assessed heterogeneity and publication bias.ResultsWe identified 33 studies including 2,664 participants with post-stroke depression and 5,460 without (314 participants not classified). Low education (< = 8 years) was associated with post-stroke depression in studies which defined depression as score of mild and above on a depression rating scale (OR 1.47 95% CI 1.10–1.97, p<0.01) but not in studies where depression was defined as severe depressive symptoms or a clinical diagnosis of major depression (OR 1.04 95% CI 0.90–1.31, p = 0.60). Low education was not associated with an increased risk for post-stroke depression in studies that adjusted for age and sex (OR 0.86 95% CI 0.50–1.48 p = 0.58). Those with post-stroke depression had fewer years of education than those without post-stroke depression (MD 0.68 95% CI 0.05–1.31 p = 0.04). Few studies adjusted for vascular risk factors or stroke severity. Heterogeneity between studies was moderate and was partly explained by severity of depression. In the one study identified premorbid IQ did not differ between those with post-stroke depression (mean IQ 10.1.8 SD 9.8) vs those without (mean IQ 104 SD 10.1). There were no studies that examined childhood socioeconomic status and risk of post-stroke depression.ConclusionsHaving less education is associated with an increased risk of post-stroke depressive symptoms but with large confidence intervals and heterogeneity. Future studies should explore the relationship between early and late life risk factors to improve risk identification and to target prevention and treatment strategies.
Highlights
Stroke is the commonest cause of dependency in adults in the developed world [1] and causes cognitive, physical and psychiatric disabilities
Low education (< = 8 years) was associated with post-stroke depression in studies which defined depression as score of mild and above on a depression rating scale but not in studies where depression was defined as severe depressive symptoms or a clinical diagnosis of major depression
Low education was not associated with an increased risk for post-stroke depression in studies that adjusted for age and sex
Summary
Stroke is the commonest cause of dependency in adults in the developed world [1] and causes cognitive, physical and psychiatric disabilities. Several risk factors for post-stroke depression have been proposed These include gender, medical and psychiatric history [3, 4], age, and social support [4] as well as factors relating to the stroke such as severity and degree of resulting disability [3]. Evidence supporting these factors is mixed and they only explain some of the variance in post-stroke depression. Depression after stroke is common and is associated with poorer recovery Risk factors such as gender, age and stroke severity are established, but it is unclear whether factors from earlier in life might contribute
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