Abstract
The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown. Our aims were to: (1) estimate the proportion of stroke patients with a problematic substance use as defined by clinical screening scales; (2) determine the proportion of PSD at three months of follow-up; (3) explore if the baseline severity in substance use and its evolution are independent predictors of PSD. A cohort of first-ever non-severe stroke adult patients was screened at baseline and three months post-stroke using recommended cut-off scores of standardized scales for tobacco, alcohol and cannabis abuse. PSD was defined using the Center of Epidemiological Studies Depression scale score. Out of the 244 eligible patients, 74 (30.3%) presented a problematic substance use, including 21 (8.6%) polydrug abusers. Among these patients, the prevalence of PSD was 50.8%, including 29.5% of severe depression. The severity of tobacco dependence at baseline was found to double the risk (OR 1.59, 95% CI 1.05–2.43) of presenting a PSD, independently of previously reported risk factors. We found no significant evidence for an effect of the evolution in substance use at follow-up. Addictive disorders are part of the critical unmet needs that should be addressed in the management of PSD.
Highlights
The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown
Smoking, drinking and illicit drug consumption are among the most common modifiable life-style stroke risk factors. These lifestyle habits are usually reported in stroke s tudies10, related clinically defined problematic substance use are unfrequently evaluated in clinical practice while their presence might represent a potential marker of psychological fragility and preclude the ability to achieve lifestyle changes that are requested following stroke
To the best of our knowledge, for the strongest argument driving the move towards considering problematic substance use as a potential risk factor for PSD appeared in Perrain et al.’s meta-analysis on the clinical risk factors of PSD11
Summary
The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown. According to recent meta-analyses, the most consistent predictors of post-stroke depression (PSD) are higher functional disability, stroke severity, cognitive impairment, personal history of a mood disorder and a lack of social support, while hemisphere or lesion location or subtype of stroke, age and gender have been less consistently reported to be associated with an higher risk of PSD6–8. These metaanalyses suggest there are different risk factors for PSD at different time points after the stroke. Alcohol consumption had a mean RR < 1: 0.83 (95% CI 0.49–1.42) and with some potential biases
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