Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups

Abstract

Background Post-stroke depressive symptoms are prevalent and impairing, and elucidating their course and risk factors is critical for reducing their public health burden. Previous studies have examined the course of post-stroke depression, but distinct depressive symptom dimensions (eg, somatic symptoms, negative affect [eg, sadness], anhedonia [eg, loss of interest]) may vary differently over time. Objective The present study examined within-person and between-person associations between depressive symptom dimensions across 3 timepoints in the year following discharge from in-patient rehabilitation hospitals, as well as the impact of multiple clinical variables (eg, aphasia). Methods Stroke survivors completed the Center for Epidemiologic Depression Scale (CES-D) at discharge from post-stroke rehabilitation (“T1”) and at 3-month (“T2”) and 12-month (“T3”) follow-ups. Scores on previously identified CES-D subscales (somatic symptoms, anhedonia, and negative affect) were calculated at each timepoint. Random intercept cross-lagged panel model analysis examined associations between symptom dimensions while disaggregating within-person and between-person effects. Results There were reciprocal, within-person associations between somatic symptoms and anhedonia from T1 to T2 and from T2 to T3. Neither dimension was predictive of, or predicted by negative affect. Conclusions The reciprocal associations between somatic symptoms and anhedonia may reflect a “vicious cycle,” and suggest these 2 symptom dimensions may be useful indicators of risk and/or intervention targets. Regularly assessing depression symptoms starting during inpatient rehabilitation may help identify stroke survivors at risk for depression symptoms and facilitate early intervention.

The presence of anhedonia in individuals with subacute and chronic stroke: an exploratory cohort study

“…Only the chronic group showed a decreased sense of vigor-activity related to anhedonia, suggesting the long-term negative impact of anhedonia on engaging in a healthy active lifestyle. These results are in line with a recent previous study suggesting the role of anhedonia as a predictor of somatic symptoms of depression, such as fatigue, over the first year after discharge from rehabilitation (Ashaie et al, 2023). Our findings also underlines the likely role of anhedonia in generating a deteriorating looping effect at a behavioral level (Mallorqui et al, 2022).…”

“…Despite the substantial overlap between apathy and anhedonia, the former is associated with an impairment in selecting future behaviors based on emotional signals, while anhedonia is characterized by diminishing sensitivity to everyday pleasures and positive mood, crucial aspects for goal-directed engagement in rewarding activities ( Verrienti et al, 2023 ). Considering the role of anhedonia in motivational aspects crucial for stroke survivors’ recovery, a recent study by Ashaie et al (2023) explored the association between three dimensions of PSD somatic symptoms, negative affect, and anhedonia. They found that anhedonia predicted subsequent increases in somatic symptoms during the first year after rehabilitation discharge, indicating its impact on physical distress rather than stroke itself.…”

“…They found that anhedonia predicted subsequent increases in somatic symptoms during the first year after rehabilitation discharge, indicating its impact on physical distress rather than stroke itself. In this regard, the authors emphasized the importance of examining specific dimensions of PSD, such as anhedonia, to understand their development and etiology and thus be able to guide clinicians in implementing targeted treatments and improving therapeutic outcomes ( Ashaie et al, 2023 ). Currently, no previous study has examined the presence of anhedonia in patients with both ischemic and hemorrhagic stroke and over a wide range of time post-stroke.…”