Frequency, Management, and Predictors of Abnormal Mood After Stroke

Abstract

Mood disorders are an important consequence of stroke. We aimed to identify significant, clinically useful predictors of abnormal mood after stroke. The Auckland Regional Community Stroke (ARCOS) study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand, over a 12-month period from 2002 to 2003. All patients were followed up 6 months after stroke onset and abnormal mood was assessed using the 28-item General Health Questionnaire (GHQ-28) administered as part of a structured telephone interview. Multivariate stepwise logistic regression was used to develop a predictive model for "caseness" (score of > or = 5 on the GHQ-28) based on several premorbid patient and clinical variables assessed at baseline and 28 days of follow up. Of patients available at 6 months (n=1172), complete data on mood was available from 739 (60%) patients and 27% (95% confidence interval, 24 to 30%) were defined as cases. Key baseline predictors of abnormal mood were disability and history of depression after adjustment for sex, age, and comorbidity, but the model failed to predict a large amount of the variation in caseness (C statistic 0.587). This study emphasizes the complex nature of mood disturbance after stroke and that multiple factors are likely to contribute to mood disorders. A simple, clinically applicable, predictive model in stroke care appears difficult to develop.