Depression in stroke patients with left and right hemisphere lesions. A study in geriatric rehabilitation in-patients

The Sunnybrook Stroke Study

“…As mentioned previously, however, most studies of depression in stroke patients have found no differences in prevalence of depression between right-and left-hemisphere lesions, regardless of the nature of the sample or the assessment measures utilized. 7 Taken together, these results suggest that depression after stroke may not be significantly different from any other depressive illness in late life with respect to risk factors. 1 This lack of specific predictors for poststroke depression has been used as the rationale for the need to screen all stroke patients for depression.…”

“…The nature of the inception cohort (consecutive admissions to a regional stroke center) places the sample in the middle of a continuum of those studies that have focused on rehabilitation units or inpatient medical wards and those studies of community samples. Samples from rehabilitation units tend to be preselected for positive rehabilitation potential, 7 while the published studies from medical inpatient wards, largely American, have tended to be much younger and may have been influenced by regional practice patterns in terms of criteria for admission. These studies may include patients with more severe and persistent disabilities.…”

“…6 A recent review of 25 studies that examined the relationship between depression and lesion laterality noted 14 studies that showed no differences between right-and left-sided lesions, 8 studies that showed that depression was more common with left-sided lesions, and 3 studies that demonstrated that depression was more common with right-sided lesions. 7 Numerous methodological problems in poststroke depression research have been suggested to account for the differences in these findings. These include the definition and classification of stroke, 8 the phenomenology and nosology of depressive symptoms, 9 the validity of the rating methodology employed, 4 and differences in the selected cohorts (acute inpatients versus admitted rehabilitation samples versus community samples).…”

“…These include the definition and classification of stroke, 8 the phenomenology and nosology of depressive symptoms, 9 the validity of the rating methodology employed, 4 and differences in the selected cohorts (acute inpatients versus admitted rehabilitation samples versus community samples). 7 In an attempt to address some of these concerns, the present study was designed to prospectively follow a large, relatively unselected sample of carefully diagnosed acute stroke patients and determine the frequency, severity, and course of depressive symptoms, their clinical correlates, and their effects on functional outcome.…”

Lesion Location and Poststroke Depression

“…‡ Six studies made no specific mention regarding blinding of assessors. 28,33,37,40,42,44 Although blinding of both the radiologist and psychiatrist helps to reduce interview and detection bias, in the case of the psychiatrist, the clinical presentation (eg, side of hemiparesis) of a stroke patient provides clues regarding the location of the stroke. A solution would be to ensure that all assessors involved are unaware of the study's hypotheses and prediction.…”