Depression in Stroke Survivors: Ten-Year Follow-Up. Determinants of the Natural Course of Depressive Symptoms in Stroke Survivors in the Netherlands: The SMART-Medea Study

A De Bekker,M.I Geerlings,I.E Uitewaal-Poslawsky,J.M De Man-Van Ginkel

doi:10.1016/j.jstrokecerebrovasdis.2021.106272

Abstract

ObjectivesStroke is the second most common cause of death and a major cause of disability. Besides the physical consequences, depressive symptoms are frequent in the aftermath after stroke. Every year, approximately 15 million stroke survivors worldwide are at risk of developing post-stroke depression. In this study we describe the natural course of depressive symptoms in stroke patients over a long-period of time post stroke and identify associated determinants. Materials and methodsFrom the Second Manifestations of ARTerial disease-Memory, depression and aging (SMART-Medea) study, an observational prospective cohort study, we selected patients with cerebrovascular disease, and used the biannually collected data of the Patient Health Questionnaire-9 for depressive symptoms. A score of ≥10 indicated the presence of depressive symptoms. A multinomial logistic regression analysis was used to identify prognostic determinants for courses of depressive symptoms after stroke. ResultsDuring a mean follow-up time of 7.9 years, 62% of the 172 participants was never depressed, 19% had a single episode and 19% had recurrent depressive symptoms. Physical function was associated with increased risk for single episode and recurrent depressive symptoms (OR=1.06 [1.01-1.11]). OR's for social, mental and (vascular) comorbidities variables were not significant. Participants’ physical function was only measured at baseline. Several relevant variables were not present in this dataset, including information about clinical events during follow-up. ConclusionNearly 40% of the participants are confronted with depressive symptoms on the long-term. Physical function plays a substantial part for stroke survivors in the development of these symptoms.

Highlights

Stroke is one of the leading causes of mortality and a major cause of disability, due to impairments in functioning, limitations in activities, and restrictions in societal participation.[20]
The SMART-Medea study is an ancillary study to the SMART-MR study,[32] which has been described in further detail elsewhere.[22]. We selected from this cohort all patients (n=192) with a diagnosis related to cerebrovascular diseases, including a diagnosis of Transient Ischemic Attack (TIA), medical diagnosis of stroke at inclusion or a medical history of stroke, regardless of the presence of depressive symptoms at baseline
The majority suffered from a single episode, one third had intermittent depressive symptoms and less than a quarter suffered from a chronic course of depressive symptoms

Summary

Introduction

Stroke is one of the leading causes of mortality and a major cause of disability, due to impairments in functioning, limitations in activities, and restrictions in societal participation.[20] These consequences vary widely between stroke survivors, the most common consequences are physical impairments, communication disorders, cognitive and emotional problems, and mood. Common psychological consequences after stroke are depressive feelings, fatigue, anxiety- and sleep disorders.[36] Psychosocial consequences, such as depressive symptoms, often hinder optimal recovery from stroke.[18]. These depressive symptoms are associated with higher functional dependency, poor prognosis for further recovery, significant loss of quality of life, and higher mortality after 12 months within stroke survivors.[5,9,32,33]

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