Abstract
ObjectiveWe tested whether the severity of depressive symptoms in acute stroke and 4 years later are predictors of long-time survival.MethodWe evaluated the severity of stroke in 82 patients with acute stroke by the Barthel index, the Scandinavian Stroke Scale and the Orgogozo scale, and we also quantified the severity of depressive symptoms by the Beck and the Hamilton scales in the first week of stroke, in 1995. We re-evaluated the scales 4 years after stroke in 41 out of 48 survivors. We checked the survival status of the initial cohort 18 years after stroke. In the assessment Kaplan-Meier graphs were constructed and the outcomes between groups were compared with log-rank tests.ResultsClinically important depressive symptoms (≥10 on the Beck scale) was present in 16 patients (19,5%) with acute stroke one week after admission. Case fatality was 41% at 4 years and 84% at 18 years after stroke. Those patients who survived at 4 years were significantly younger (p<0,05). Depressive symptoms in acute stage were not independent predictor of the length of survival. More severe strokes were associated with more severe depressive symptoms 4 years after stroke. In the survival subgroup of patients, those who had more severe depression (≥10 on the Beck scale) at 4 years, had shorter post-stroke survival than those with milder or no depression (Mann-Whitney test, p = 0.022; log-rank-test, p = 0.047). In multivariate analyses, adjusted for age, sex, stroke severity and the severity of depressive symptoms, age, sex and stroke severity remained the significant predictors of the length of survival.ConclusionsThe severity of depressive symptoms either in the acute phase or 4 years after stroke is not an independent predictor of the length of survival in an 18-year follow-up.
Highlights
Stroke represents the second most common cause of death worldwide following only coronary heart diseases [1], and it often has diverse, long-term physical and neuropsychological consequences [2]
In multivariate analyses, adjusted for age, sex, stroke severity and the severity of depressive symptoms, age, sex and stroke severity remained the significant predictors of the length of survival
We found that more severe strokes were associated with more severe depressive symptoms 4 years after stroke (Fig 2)
Summary
Stroke represents the second most common cause of death worldwide following only coronary heart diseases [1], and it often has diverse, long-term physical and neuropsychological consequences [2]. Stroke is a leading cause of serious long-term disability in the United States [3]. WHO has projected that by 2030 unipolar depressive disorder will become the second leading cause of burden of disease worldwide, as measured by the disability-adjusted life years [4]. Data available from 61 studies showed that depressive symptoms were present in 31% (28– 35%) of all stroke survivors at any time during follow-up [7]. Ayerbe et al [8] found similar estimates: the pooled prevalence of poststroke depression (PSD) at any time point was 29%, with a prevalence of 28% within a month of stroke, 31% at 1–6 months, 33% at 6 months to 1 year, and 25% at more than 1 year, respectively
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