Post-stroke Depressive Symptoms Research Articles

Prediction of depressive symptoms up to three years post-stroke

To describe the long-term course of depressive symptoms up to 3 years post-stroke and to develop a prediction model for depressive symptoms 1 and 3 years post-stroke. Longitudinal follow-up study. Data were analysed for 131 patients with a first-ever supratentorial stroke admitted for inpatient rehabilitation in the Netherlands The Center for Epidemiologic Studies-Depression scale was used to assess post-stroke depressive symptoms at 6 months, 1 and 3 years post-stroke. Post-stroke depressive symptoms were present 6 months, 1 year and 3 years post-stroke in 23.7%, 25.2% and 16.0% of the patients, respectively. At all 3 assessments post-stroke depressive symptoms were absent in 65.6% of the patients and present in 12.2% of the patients. Of the patients with post-stroke depressive symptoms 6 months post-stroke, 41.9% had recovered from post-stroke depressive symptoms 3 years post-stroke. The most important predictor of post-stroke depressive symptoms 1 and 3 years post-stroke was post-stroke depressive symptoms 6 months post-stroke (area under the curve 0.75 and 0.85). Male gender was an additional predictor for post-stroke depressive symptoms 3 years post-stroke. Long-term post-stroke depressive symptoms are highly predictable at 6 months post-stroke. If a patient has not recovered from post-stroke depressive symptoms within the first 6 months post-stroke there is a high risk of chronic post-stroke depressive symptoms.

The role of activity restriction in poststroke depressive symptoms.

Little is known about the determinants of poststroke depression. The Activity Restriction Model of Depressed Affect (ARMDA) may be helpful in understanding poststroke depression but has never been tested in that context. The goal of this study was to examine the relation between activity restriction and depressive symptoms in stroke survivors during the period following discharge from the hospital. Participants (N = 197) were assessed on three occasions: (1) time 1 (T1), 3 weeks following discharge; (2) time 2 (T2), 3 months after discharge; and (3) time 3 (T3), 6 months after discharge. Although both stroke severity and activity restriction were significantly related to depressive symptoms, the relation between stroke severity and depression was no longer significant after controlling for activity restriction. Moreover, restrictions in daily activities and social roles were both related to depressive symptoms, but these relations were found to vary during the course of the period following discharge. These findings support the ARMDA and have practical implications for the prevention of poststroke depression.

The perception of emotional facial expressions in stroke patients with and without depression.

Emotion perception may be impaired after stroke. No study on emotion perception after stroke has taken the influence of post-stroke depressive symptoms into account, although depressive symptoms themselves may hamper emotion perception. To compare the perception of emotional facial expressions in stroke patients with and without depressive symptoms. Twenty-two stroke patients participated whose depressive symptoms were classified using the Montgomery-Åsberg Depression Rating Scale (cutoff = 10) and who were compared with healthy controls. Emotion recognition was measured using morphed images of facial expressions. Patients with depressive symptoms performed worse than controls on all emotions; patients without depressive symptoms performed at control level. Patients with depressive symptoms were less sensitive to the emotions anger, happiness and sadness compared with patients without depressive symptoms. Post-stroke depressive symptoms impair emotion perception. This extends findings in bipolar disorder indicating that emotion perception deficits are strongly related to the level of depression.

Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation

Subthreshold depression (sD) and cognitive impairment but not demented (CIND) in stroke patients are associated with poorer rehabilitative outcomes. Their diagnosis can easily be operationalized using validated scales. The aim of the study was to ascertain the prevalence of depressive symptoms and cognitive impairment in stroke patients during three crucial stages of the rehabilitative process, viz. upon admission, upon planned discharges from rehabilitation hospitals and at 6 months post-stroke, using validated scales like the Geriatric Depression Scale and Abbreviated Mental Test (recommended by the British Geriatric Society). Their baseline risk factors were also ascertained. On admission, the prevalence of depressive symptoms and cognitive impairment was 60% and 54% respectively. The prevalence upon planned discharges and 6 months post-stroke, respectively, of depressive symptoms was 38% and 34% and that of impaired cognition was 33% and 40%. Baseline independent correlates at 6 months post-stroke depressive symptoms were: recurrent stroke (OR 3.34); on admission cognitive impairment (OR 4.78) and ADL dependence (OR 5.28). And that of cognitive impairment were: increasing age (OR 8.07); post-stroke dysphagia (OR 4.58); on admission cognitive impairment (OR 23.95) and on admission depressive symptoms (OR 3.50). Continuous screening and appropriate intervention, especially at baseline, would significantly decrease the burden posed by stroke patients with such psychological impairments in the community.

Predictors of Psychological and Somatic Components of Poststroke Depression: A Longitudinal Study

Purpose: Depression after stroke is common and increases morbidity and mortality in the first years after stroke onset. Nevertheless, little is known about the role of psychosocial factors on the etiology of depression in early as well as in the late poststroke stages. The aim of our study was to investigate the influence of stroke survivors’ mental impairment as well as the quality of their social relationships on the development of poststroke depression (PSD). Method: The study used a longitudinal design. Eighty-one German stroke patients were investigated twice, directly after discharge (on the average of 3 months after stroke onset) and 1 year later. Hierarchical regression analyses and cross-lagged partial correlation analyses tested direct and indirect mediating effects of potential predictors on poststroke depressive symptoms. Results: Time 1 patients’ perceived cognitive and emotional functioning predicted psychological depressive symptoms at Time 2. Quality of patients’ social relationships mediated the effect of the stroke-related emotional deficits on depression. Conclusion: In contrast to the previous research, the study provided more evidence for causal influence of different risk factors on PSD. Results support the biopsychosocial model of PSD. Early and late PSD seem to be based on partially different etiological mechanisms.

Hopeful thinking, participation, and depressive symptoms three months after stroke

This study was designed to examine hopeful thinking, depressive symptoms, and participation in meaningful activities and roles for survivors 3 months after stroke. It was predicted that: (a) participation would predict lower depressive symptoms; (b) higher hopeful thinking (i.e., beliefs in one's goal pursuit abilities) would predict lower depressive symptoms; and (c) higher hopeful thinking would predict better participation. Three months after stroke, 110 participants completed measures of disability, participation, depressive symptoms, and hopeful thinking. Contrary to the first hypothesis, participation did not independently predict depressive symptoms after controlling for more basic activity limitations (physical, memory, communication). As predicted, hopeful thinking was the strongest predictor of depressive symptoms. Hopeful thinking did not directly predict participation, but it moderated relationships of activity functioning to participation. Results suggest that participation and hopeful thinking may contribute to the understanding of post-stroke depressive symptoms, although additional research is needed to further elucidate such contributions.

Therapeutic Exercise and Depressive Symptoms After Stroke

To examine the effect of exercise on depressive symptoms and the effect of baseline depressive symptoms on the benefits from exercise in stroke survivors who have completed acute rehabilitation. Planned secondary analysis of the data from a 9-month randomized, controlled trial. Participant homes. One hundred stroke survivors who had completed acute rehabilitation. A progressive, structured, 3-month physical exercise program. Demographics, stroke characteristics, impairments, functional limitations, the Geriatric Depression Scale, the Stroke Impact Scale, and the Medical Outcomes Study 36-Item Short Form. Baseline rates of depressive symptoms and other stroke sequelae were similar between the two arms. Ninety-three participants were assessed immediately after the intervention (3 months after enrollment), and 80 were assessed 9 months after enrollment. Six (14%) of the exercise group and 16 (35.6%) of the usual-care group had depressive symptoms at 3 months (P = .03). At 9 months, three (7.5%) of the exercisers had significant depressive symptoms compared with 10 (25%) who received usual care (P = .07). Participants with and without baseline depressive symptoms had equivalent treatment-related gains in impairments and functional limitations, but only participants with depressive symptoms had improved quality of life. Exercise may help reduce poststroke depressive symptoms. Depressive symptoms do not limit gains in physical function due to exercise. Exercise may contribute to improved quality of life in those with poststroke depressive symptoms.

Depressive symptoms after stroke and relationship with dementia: A three-year follow-up study.

To determine frequency, determinants, and time course of poststroke depressive symptoms (DS) and their relationship with dementia. Two hundred two consecutive stroke patients were prospectively evaluated for DS, followed up over a 3-year period. Patients with Montgomery and Asberg Depression Rating Scale (MADRS) scores of >/==" BORDER="0">7 were considered as having DS. The severity of the neurologic deficit, functional outcome, and dementia were quantified with the Orgogozo Scale, modified Rankin Scale, Informant Questionnaire on Cognitive Decline in the Elderly, and an extensive battery of neuropsychological tests. DS were present in 43% of survivors after 6 months, 36% after 12 months, 24% after 24 months, and 18% after 36 months. The severity of the neurologic deficit at admission was the only independent predictor of DS at month 6. DS at month 6 were more frequent in patients with previous depression, dementia, and right superficial lesions. Younger age and right superficial lesions were the two variables independently associated with the presence of DS at month 36. The time course of the various DS differed, sadness remaining frequent 3 years after stroke (50%), whereas slowness, psychic slowness, lack of energy, and concentration difficulties remained frequent at month 36 in patients with dementia. DS are frequent after stroke. Their time course varies and depends on the cognitive status; this variation contributes to differences among previous studies on poststroke depression.

Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study.

The purpose of our study was to determine the functional and neuroanatomic correlates of poststroke depressive symptoms. Patients with consecutive admissions to a regional stroke center for new-onset unilateral hemispheric stroke who met World Health Organization and National Institute of Neurological and Communicative Disorders and Stroke criteria were eligible for inclusion in a longitudinal study. Acutely, patients underwent CT scanning, and at 3 months and 1 year after stroke, depressive symptoms were assessed by using both the Montgomery-Asberg Depression Rating Scale and the Zung Self-Rating Depression Scale. The Functional Independence Measure (FIM) served as an indication of functional outcome and was obtained at 1 month, 3 months, and 1 year after stroke, along with other demographic information. The Talairach and Tournoux stereotactic atlas was used for the primary determination of CT lesion localization. Lesion proximity to the anterior frontal pole was also measured. Eighty-one patients participated in the longitudinal study. Stepwise linear regression analyses generated a highly significant model (F(3,76)=9.8, R(2)=28%, P<0.0005), with lower 1-month total FIM scores, living at home, and damage to the inferior frontal region predicting higher depression scores at 3 months. Similarly, lower 3-month total FIM scores correlated with higher 3-month depression scores, and lower 1-year total FIM scores correlated with higher 1-year depression scores. Functional measures correlated with poststroke depression across time and, together with neuroanatomic measures, predicted depressive symptoms longitudinally. Although inferior frontal lesion location, irrespective of side, appeared to play a role as a risk factor in this study, the degree of functional dependence after stroke imparted the greatest risk.

Handicap in stroke survivors

Background and purpose: As survival following stroke improves, individuals are more likely to live with the aftermath of stroke rather than immediately die from it. The purpose of this study was to examine the consequences of stroke on the life activities of survivors in the social realm (stroke handicap) using the framework of the World Health Organization's International Classification of Impairments, Disabilities and Handicaps. Methods: Multivariate analysis of variance was applied to cross-sectional data from a clinical study to investigate the correlates of handicap in a cohort of hemispheric stroke survivors at 3 months (n= 145) and at 1 year (n= 135) after stroke onset. Handicap was assessed with the Reintegration to Normal Living Index, impairment by the Adams' Hemispheric Stroke Scale and Zung Depression Scale, and disability by the Functional Independence Measure. Environmental variables in the model included marital status and receipt of rehabilitation therapy. Results: Physical disability and post-stroke depressive symptoms were associated with handicap at both follow-up periods (p<0.05). Cognitive disability and impairments from a previous stroke were also associated with handicap (p<0.01), but only at 1 year. The presence of a spouse was found to benefit male survivors at 1 year. Conclusions: Disability and depressive symptoms restrict the meaningful life activities of stroke survivors in the first year of recovery. Social supports may be influential in reducing their impact.