Prevalence, Severity, and Predictors of Poststroke Depression in a Prospective Cohort of Jordanian Patients.

Augusto Fusco,Majdi Al Qawasmeh,Mohammad Zahran,Khalid El-Salem,Belal Aldabbour,Mays Khweileh,Amal Abuabada,Samah Elamassie,Khalid Abdelrahman

doi:10.1155/2022/6506326

Abstract

Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month (p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients (p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.

Highlights

Stroke is a significant cause of morbidity and mortality globally [1]
55 (55%) of male patients held a diploma, a university degree, or higher education, and 88.89% had any level of education
We found that patients with total and severe dependence one month after stroke were more likely to be depressed by log odds of 4.523 and 1.690 (p 0.039 and p 0.031), respectively, compared with fully independent patients

Summary

Introduction

Stroke is a significant cause of morbidity and mortality globally [1] It is the second leading noncommunicable cause of death in Jordan and a considerable source of complications and physical disability [2, 3]. Poststroke depression (PSD) is the most frequent and a very important neuropsychiatric complication. Stroke survivors who develop PSD are at a greater risk of poor functional outcomes, lower quality of life, increasing cognitive impairment, recurrent vascular events, and higher mortality than those without depression [4–6]. Several studies suggested that PSD prevalence differs with the time interval between stroke and depression assessment [7]. Surveys from the Middle East and North Africa (MENA) region reported a wide prevalence of PSD (17-73%) [10], while previous surveys from Jordan reported a range from 25% to 76% [14–17]. Studies aiming to identify risk factors predisposing to PSD have been inconsistent. The most frequently identified risk factors include the level of physical disability, stroke severity, and history of mental illness [7, 18]

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