Gender Differences in the Prevalence and Correlates of Post-Stroke Depression Among Older Stroke Survivors: Findings From a National Survey in China.

Background: Post stroke depression (PSD) is a common neuropsychiatric mood disorder believed to be under-diagnosed among stroke survivors. Objective: The aim of this study was to determine the prevalence and severity of PSD among stroke survivors in north-eastern Nigeria. Materials and Methods: A purposive sample of stroke survivors (N = 249) in six tertiary health institutions in north-eastern Nigeria completed a three-part survey. Part 1 elicited sociodemographic information and part 2 was a Patient Health Questionnaire-9, utilized to identify the presence of PSD and its severity, while part 3 was Barthel Index utilized to determine the level of independence of participants. Chi-square test was used to determine the difference in prevalence of PSD between gender, different occupational statuses, living conditions, previous history of stroke, and side of hemispheric lesion. Pearson product moment correlation coefficient was used to determine the relationship between depression and age, duration of stroke, and level of independence. Results: An overwhelming majority of the participants (93.6%) were depressed; females tend to be more depressed (P < 0.05) than males. Significant correlation was observed between age and level of independence and PSD (r = −0.157, P = 0.013 and r = 0.345, P < 0.001, respectively). However, there was no significant correlation between the duration of stroke and PSD (r = −0.111, P = 0.079). Conclusion: This study revealed a high prevalence of PSD in the study region with females being more at risk. Further, increase in age and decreased level of independence correlated with PSD.

Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are prevalent neuropsychiatric problems that are associated with high disability burden and low quality of life (QoL). This study explored the PSD-PSCI network, along with the interaction and association with QoL among Chinese older stroke survivors. Data from the 2017-2018 wave of the Chinese Longitudinal Healthy Longevity Survey were obtained to investigate the inter-relationship between PSD and PSCI among older stroke survivors. Central and bridge symptoms within the PSD-PSCI network and their association with QoL were explored. Depressive symptoms, cognitive impairment and QoL were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), Mini-Mental State Examination and the WHO QoL-brief version, respectively. The prevalence of PSD and PSCI among older stroke survivors was 31.5% and 22.1%, respectively. In the PSD-PSCI network, 'feeling blue/depressed' (CESD3, strength: 1.117) and 'Attention and calculation' (At_C, strength: 0.972) were the most influential symptoms, while 'Naming' (Nam, bridge strength: 0.175) was the most significant bridge symptom. Notably, 'Sleep disturbances' (CESD10) had the strongest association with lower QoL. This study revealed that both PSD and PSCI were prevalent among older stroke survivors. The key central and bridge symptoms in the PSD-PSCI network, along with those symptoms that negatively impact on QoL, should be prioritised in targeted interventions to enhance treatment outcomes in this population.

A variety of studies suggest the existence of a distinct phenotype of somatic depression, i.e., depression accompanied by significant somatic symptomatology. Previous research suggests that the gender difference in the prevalence of depression is primarily due to a difference in somatic depression. The aim of this study was to compare the gender difference in the prevalence of somatic depression and of depression not accompanied by significant somatic symptomatology (labelled "pure" depression) in two representative samples, the National Comorbidity Survey-Replication (NCS-R) and the Zurich Study. The gender difference in lifetime somatic depression was compared to that of pure depression based on analyses weighted back to the general population in two representative samples. The NCS-R analyses involved a narrow definition of somatic depression with items from the DSM criteria for depression--appetite, sleep, and fatigue. The analysis of the Zurich study added headaches, body image issues, and breathing difficulties to the criteria and comparison to atypical depression. In both samples, the gender difference in depressive prevalence was due to a large difference in somatic depression with other phenotypes showing little or no gender difference. The gender differences were found to be due to the somatic symptoms rather than the number of symptoms and were much larger for somatic than for atypical depression. The gender difference in the prevalence of depression results from the higher prevalence among women of a specific phenotype, somatic depression.

Post-stroke depression (PSD) negatively impacts the physical and mental well-being of stroke survivors. However, data on the prevalence and risk factors of PSD in African countries such as Cameroon are limited. This study aims to determine the prevalence and factors associated with PSD among stroke survivors at a hospital in Cameroon and inform clinical practice. The study was carried out in the Nkwen Baptist Hospital in the North West region of Cameroon. This was a hospital-based cross-sectional study. Stroke patients were systematically screened for PSD using the patient health questionnaire (PHQ-9). PSD was present if a patient scored ≥ 4 points on the scale. The multidimensional scale of perceived social support was used to assess the level of social support, the modified Rankin tool and Barthel index were used to assess functional independence, and the Fatigue assessment tool was used to assess post-stroke fatigue. A multivariate analysis was performed to identify factors associated with PSD. A total of 103 patients were included in the study. The mean age was 55.55 ± 12.15. Most patients were males (58.25%). The mean depression score was 5.17 ± 6.26. The overall prevalence of PSD was 36.89%. A higher functional impairment, post-stroke fatigue, perceived social support, recent stroke and being divorced were all associated with high PSD scores. In this study, we found a high prevalence of PSD using a systematic screening approach, suggesting that systematic screening for PSD can lead to early detection and management. Systematic screening for PSD in stroke patients can lead to early diagnosis and, consequently, early initiation of treatment. Integration of mental health support and care as part of the routine stroke is warranted.

PurposeThe purpose of this systematic review was to assess potential gender differences in prevalence and clinical relevance of insulin-related lipohypertrophy (LH).Patients and MethodsFive electronic databases (PubMed, Embase, CNKI, Wanfang and VIP) were systematically searched for studies, from inception to 1st Sep 2022, on the prevalence of insulin-related LH. The eligibility of articles was independently screened, and the included studies were evaluated using standardized quality assessment tools.ResultsA total of 22 studies mentioned the LH prevalence in different genders, of which two are about gestational diabetes; therefore, 20 studies were eventually included, providing data on 6238 patients. The prevalence of LH varied from 30.26% to 72.54%. Ten studies (4392 patients) were conducted with the adult diabetes patients of different genders over the age of 18, the total prevalence rate of LH was 51.73%, the LH prevalence in male gender was from 41.94% to 68.57% and the rate of the total population was 54.89% (2046 patients); The LH prevalence in female gender was from 33.18% to 70% and the rate of the total population was 48.98% (2346 patients), and the prevalence of LH was significantly different between male and female gender (P<0.001). Interestingly, only one study (n=1227) showed that there were dramatic differences between different genders (P<0.001), the subjects were T2DM patients, the LH prevalence rate of male vs female was 70.52% (299/424) VS 52.18% (419/803), while the other studies either only include T1DM or both T1DM and T2DM.ConclusionThe evidence shows that the results of gender differences in the LH prevalence are inconsistent with different types of DM. Probably, there is no gender differences in the LH prevalence in adult patients with T1DM, but it has a gender difference between male and female in T2DM. More strictly designed clinical studies are needed to further verify and reveal the underlying mechanisms.

Poststroke depression within the first year – phenomenology and clinical correlates from real-world data

The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. In a cross-sectional study, we assessed adult participants with confirmed first stroke with a standardized questionnaire. The Patient Health Questionnaire-9 was used to assess for depression among non-aphasic patients while the Aphasic Depression Rating Scale was administered to aphasic patients. Univariable and multivariable analyses performed to describe associations with PSD. Forty three females (58.9%) and 30 males (41.1%) who had a stroke participated. Fifty eight (79.5%) had ischemic strokes and 12 participants (16.4%) were aphasic. The prevalence of PSD among the study participants was 31.5%. PSD was higher among patients assessed within 6 months after the onset of stroke. PSD was strongly associated with the total Barthel index of activities of daily living (BIADL) score; p=0.001. There was no significant association between demographic characteristics and PSD. There is a high prevalence of unrecognized post-stroke depression. Post-stroke depression was strongly associated with the patient's inability to undertake activities of daily life. There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.

Background: Stroke is a major health problem and poststroke depression is known to be one of the frequent and severe psychiatric complications following stroke.Methods: Based on the results of structured psychiatric mental state exams and DSM diagnostic criteria, the prevalence of poststroke depression has been examined in numerous study populations throughout the world. Longitudinal examinations have documented the effect of poststroke depression on recovery from stroke.Results: The mean prevalence of poststroke major depression was 21.1 % and minor depression was 17.1% among hospitalized or outpatient samples. Community samples showed a slightly lower rate of 14.1% and 9.1%, respectively. Furthermore, the existence of poststroke depression leads to poorer physical recovery, greater cognitive impairment, and worse recovery in activities of daily living compared with non‐depressed patients. Several studies have also found that poststroke depression is associated with increased mortality compared with non‐depressed patients who had comparable strokes and similar premorbid risk factors. Finally, several studies have found that successful treatment of poststroke depression improves both cognitive and physical recovery and decreases mortality.Conclusion: The current review documents the beneficial effect of identifying and treating poststroke depression on both recovery and survival following stroke.

Background: The association between depression and stroke is well known. Few studies show that lesion side and site are associated with post-stroke depression (PSD), but there exists a vast discrepancy in the results among various studies. The prevalence of post stroke depression also varies widely. In India there is paucity in the amount of literature in this context. Early detection of depression is of prime importance for better outcomes. The study was mainly intended to find out these variations. Methods: To study the prevalence of post stroke depression, the neuroanatomical correlation of post stroke depression and impact of comorbid conditions in post stroke depression. This c ross sectional study was designed at medicine department of MGMCRI, Puducherry, India. All adult patients with stroke (>40 years) presenting to the emergency medical services (EMS) and department of medicine were enrolled. Patients fulfilling the inclusion criteria were taken up for the study after obtaining consent. Data about pre-existing comorbid illness such as diabetes, hypertension, ischaemic heart disease and substance abuse like smoking, alcohol use were collected. Complete physical examination and CNS examination were performed. The findings of CT brain were documented including the site of lesion. Depression was assessed on the 14th day after stroke using PHQ-9 questionnaire. Chi square and regression analysis were employed for statistical analysis. Results: The mean age of subjects in this study was found to be 63.84±11.40 years. The prevalence of severe depression in this study was 47%. Milder form of depression was found in 53% of the subjects. Of the total population studied, statistically significant severe depression was associated with patients who had lesion on left hemisphere. Conclusions: Post stroke depression is more associated primarily with left sided hemispheric lesions. The prevalence of significant post stroke depression in present study was 47%. This study highlights the importance of screening stroke patients for depression. Early intervention of post stroke depression can lead to better outcomes.

Background: Post-stroke depression (PSD) is a common and important comorbidity in patients after stroke. It negatively impacts stroke survivors’ outcomes. Plenty of studies have investigated risk factors for PSD, especially sex differences. However, the results remain inconsistent. In this study, we explored the prevalence and risk factors for PSD both in the acute phase and the chronic phase of stroke, emphasizing on the impact of gender in PSD. Methods: About 1094 patients with first-ever ischemic stroke were included in the study. Patients were followed up, respectively, 2 weeks, 3 months, and 12 months after stroke. Data collected included demographic and stroke-related factors, and whether patients still suffer from PSD at each time points. T-test, chi-square test, and Wilcoxon rank-sum test were used to explore the group differences between patients with PSD and without PSD, and between female and male patients. Logistic regression was performed to investigate the risk factors for PSD both in the acute and the chronic stage of stroke. Results: The prevalence of PSD was 25.4, 17.6, and 12.4%, respectively 2 weeks, 3 months, and 12 months after stroke. Female patients had higher prevalence of PSD compared with male patients (31.4 vs. 22.4% 2 weeks after stroke; 20.05 vs. 16.22% 3 months after stroke; 15.04 vs. 11.05% 12 months after stroke). In the acute stage of stroke, female gender (OR 1.686 95%CI 1.155–2.462) and National Institutes of Health Stroke Scale (NIHSS) score (OR 1.118 95%CI 1.076–1.162) were independent risk factors for PSD. However, in the chronic stage of stroke, risk factors for PSD were different. At 3 months, NIHSS score (OR 1.082 95%CI 1.037–1.128), smoking (OR 1.772 95%CI 1.163–2.701), and frontal lobe lesion (OR 2.331 95%CI 1.472–3.692) were independent risk factors for PSD. On the other hand, education level (OR 0.693 95%CI 0.486–0.998) was a protective factor. About 12 months after stroke onset, NIHSS score (OR 1.113 95%CI 1.062–1.167) and living alone (OR 3.608 95%CI 1.538–8.466) were risk factors for PSD. Conclusion: PSD is common in stroke survivors, and female patients have higher prevalence of PSD. Risk factors for PSD in the acute phase are different from that in the chronic phase of stroke. Female gender is an independent risk factor for PSD in the acute stage of stroke. Smoking, frontal lobe lesion, and living alone are predictive factors for PSD in the chronic stage of stroke. NIHSS score is a risk factor for PSD both in the acute and in the chronic stage of stroke. Further studies are needed to understand the mechanisms underlying the elevated prevalence of PSD in female.

Depression after minor stroke: Prevalence and predictors

Background and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied.Methods This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP.Results A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP.Conclusions The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

To identify the prevalence of post stroke depression (PSD) and their socio-demographic and clinical predictors among elderly stroke survivors after hospital discharge to home. In this cross-sectional study, 90 elderly stroke survivors were evaluated 14 days after hospital discharge with the following scales: National Institutes of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale - 15 items (GDS-15). PSD was defined as a score > 5 on GDS-15. After univariate analyses, a multivariate logistic regression model was built to identify independent predictors of PSD. Fourteen days after hospital discharge, 27.7% (95%CI 18.1 to 37.2) of elderly stroke survivors had PSD. Functional dependence was the only independent predictor of PSD (OR: 1.04 95%CI: 1.01 to 1.09; p = 0.02). After stroke, depressive symptoms are common among elderly survivors. The degree of functional dependency is the main predictor of PSD among elderly stroke patients in Brazil.

Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis

Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and men's different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.