Depressive symptoms in stroke patients: A 13 month follow-up study of patients referred to a rehabilitation unit

Farner, Lasse; Wagle, Jørgen; Engedal, Knut; Flekkøy, Kjell; Wyller, Torgeir Bruun; Fure, Brynjar

doi:10.1016/j.jad.2010.05.025

Cited by 68 publications

(71 citation statements)

References 53 publications

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“…2,3 Poststroke incidence is an estimate of natural history that has been scarcely investigated. 2,12,13 The prevalence and poststroke incidence observed in this study, which are largely stable throughout the follow-up, are estimates suggesting a persisting risk of depression among stroke patients and a dynamic natural history of depression in the long term after stroke. The cumulative incidence of depression in stroke cohorts has been so rarely reported in previous studies that the overall importance of depression among stroke patients has probably been underestimated.…”

Section: Discussionmentioning

confidence: 54%

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The Natural History of Depression up to 15 Years After Stroke

Ayerbe

Ayis

Crichton

et al. 2013

Stroke

171

122

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A lthough depression is a recognized outcome of stroke, 1 most studies investigating depression after stroke have limitations, including selection bias, short follow-up, and small sample size. 2,3 The prevalence of depression in the first few years after stroke has been reported in several studies. 2 Nonetheless, evidence is poor or lacking on other estimates of the long-term natural history of depression, such as the poststroke incidence, cumulative incidence, time of onset, duration, and recurrence rate.2 Interventions for depression after stroke only show limited effect. Whether these interventions had been started at the right time after stroke and given for an adequate length of time to obtain maximal sustained response has been questioned. 4 In this article, the poststroke incidence, cumulative incidence, prevalence, time of onset, duration, and recurrence rate of depression up to 15 years after stroke are estimated in a population-based study. MethodsFirst in a lifetime stroke patients were recruited from the South London Stroke Register (SLSR), a prospective population-based stroke register covering an inner-city population of 271 817. 5 Data from patients, registered in the SLSR between January 1, 1995, and December 31, 2009, and followed up between April 1, 1995 (first 3 months of follow-up assessments), and August 31, 2010, were used (patients at registration, N=4022).Patients were registered during the acute phase of stroke and were then followed up for 3 months after stroke, 1 year after stroke, and annually thereafter. The World Health Organization definition of stroke was used.6 Follow-up was by postal questionnaire or interview, depending on the capacity of patient to fill in the questionnaire. Such capacity was judged by the patient, the next of kin, or the field worker in a preceding follow-up assessment. Patients unable to complete the follow-up questionnaire, and those not returning them by post, were telephoned to arrange face-to-face interviews or have another follow-up questionnaire posted. Patients who could not be followed up at one time point remained registered and were contacted again for the following annual assessment. At follow-up, patients were Background and Purpose-Evidence on the natural history of depression after stroke is still insufficient to inform prognosis and treatment strategies. This study estimates the incidence, cumulative incidence, prevalence, time of onset, duration, and recurrence rate of depression up to 15 years after stroke. Methods-Data from patients registered in the South London Stroke Register between 1995 and 2009 were used (N=4022 at registration. Maximum number of participants for these analyses n=1233). Depression was assessed in all patients with the Hospital Anxiety and Depression Scale (scores >7=depression) 3 months after stroke, 1 year after stroke, and annually thereafter up to 15 years after stroke. Inverse probability weighting was used to calculate the estimates accounting for missing data. Results-The poststroke incidence of depression range...

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Section: Discussionmentioning

confidence: 54%

“…Other studies following stroke patients for up to 3 years published similar results. [12][13][14] The increase in recurrent episodes observed during the 15-year follow-up explains why depression starting shortly after stroke and having short duration has a stable prevalence.…”

Section: Discussionmentioning

confidence: 99%

The Natural History of Depression up to 15 Years After Stroke

Ayerbe

Ayis

Crichton

et al. 2013

Stroke

171

122

View full text Add to dashboard Cite

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“…Differences in subject samples, diagnostic and psychiatric assessment methods, and time of assessment may explain the general discrepancy between poststroke prevalence rates. However, the average prevalence rate of depression among people 65 years and above in the general population has been reported to be 19 %, a much lower rate than that seen in most stroke populations [33].…”

Section: Discussionmentioning

confidence: 90%

“…Hs-CRP highsensitivity C-reactive protein, HCY homocysteine incidence of poststroke depression was 33.5 % [2]. Other studies had reported that the frequency of PSD ranging from 22.1 to 48 % [33][34][35]. Differences in subject samples, diagnostic and psychiatric assessment methods, and time of assessment may explain the general discrepancy between poststroke prevalence rates.…”

Section: Discussionmentioning

confidence: 96%

Serum Levels of High-sensitivity C-Reactive Protein at Admission Are More Strongly Associated with Poststroke Depression in Acute Ischemic Stroke than Homocysteine Levels

et al. 2015

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Inflammatory processes have fundamental roles in depression. The primary purpose of this study was to assess the serum levels of high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (HCY) at admission to the presence of poststroke depression (PSD). From December 2012 to December 2013, first-ever acute ischemic stroke patients who were admitted to the hospital within the first 24 h after stroke onset were consecutively recruited and followed up for 6 months. Serum levels of Hs-CRP and HCY were tested at admission. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for depression at 6 months after stroke. Ninety-five patients (42.0%) showed depression (major + minor) at 6 months after admission, and in 69 patients (30.5%), this depression was classified as major. In the 69 patients with major depression, our results showed significantly higher Hs-CRP and HCY levels at admission than patients without major depression. After adjusting all other possible covariates, Hs-CRP and HCY still were independent predicators of PSD with adjusted OR of 1.332 (95% CI, 1.230-1.452; P < 0.001) and 1.138 (95% CI, 1.072-1.274; P < 0.001), respectively. The area under the receiver operating characteristic curve values of Hs-CRP and HCY were 0.765 (95% CI, 0.701-0.9825) and 0.684 (95% CI, 0.610-0.757) for PSD, respectively. The prognostic accuracy of combined model (HCY and Hs-CRP) was higher compared to those biomarkers alone and other markers. Elevated serum levels of Hs-CRP and HCY at admission were found to be associated with depression 6 months after stroke, suggesting that these alterations might participate in the pathophysiology of depression symptoms in stroke patients.

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“…People with stroke who have depression exhibit greater utilization of health care services (Jia et al, 2006), ultimately resulting in significantly higher health care costs than for their counterparts without depression (Husaini et al, 2013). In addition, depression is a predictor of poor functional outcomes after stroke (Farner et al, 2010;Wulsin et al, 2012). Currently, limited evidence supports that poststroke rehabilitation designed to achieve functional recovery, minimize disability, and reintegrate people back into the community decreases the risk of depression and improves QOL in this population (Hou et al, 2013).…”

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confidence: 99%

Improving Quality of Life and Depression After Stroke Through Telerehabilitation

Linder

Rosenfeldt

Bay

et al. 2015

The American Journal of Occupational Therapy

105

112

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OBJECTIVE. The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke. METHOD. A multisite randomized controlled clinical trial was completed with 99 people <6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy + home exercise program, and participated in an 8-wk home intervention. RESULTS. We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups. CONCLUSION. A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke.

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Depressive symptoms in stroke patients: A 13 month follow-up study of patients referred to a rehabilitation unit

Cited by 68 publications

References 53 publications

The Natural History of Depression up to 15 Years After Stroke

The Natural History of Depression up to 15 Years After Stroke

Serum Levels of High-sensitivity C-Reactive Protein at Admission Are More Strongly Associated with Poststroke Depression in Acute Ischemic Stroke than Homocysteine Levels

Improving Quality of Life and Depression After Stroke Through Telerehabilitation

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