Major depression in stroke patients. A 3-year longitudinal study.

Abstract

Background and Purpose: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied.Methods: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years.Results: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19%37e at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60%o of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression.Conclusions: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based on the period of time since the stroke event. (Stroke

The etiology of poststroke depression: a review of the literature and a new hypothesis involving inflammatory cytokines

“…In subsequent studies, Starkstein et al, 4 Astrom et al, 5 Morris et al, 6 Herrmann et al, 7,8 Vataja et al, 9,10 all found significant associations between left frontal and/or left basal ganglia lesions and major poststroke depression. Furthermore, Bolla-Wilson et al 11 and Spalletta et al 12 found an association between major depression in patients with left hemisphere stroke and cognitive impairment, while Spalletta 13,14 found an association between unawareness of emotions and right hemisphere stroke.…”

Neuropsychiatric outcomes of stroke

“…Estimates from individual studies assessing major depression meeting DSM criteria varied across studies from 2% during admission 15 in one cohort to 31% at three months in a different cohort. 16 In the latter cohort, major depression meeting DSM criteria was assessed over three years. Estimates were 31% at three months, 16% at 1 year, 19% at 2 and 29% at three years after stroke (only 50 participants remained in the final cohort).…”

“…Estimates were 31% at three months, 16% at 1 year, 19% at 2 and 29% at three years after stroke (only 50 participants remained in the final cohort). 16 Population based stroke registers with long-term follow-up [17][18][19] demonstrate that depression after stroke is a chronic relapsing disorder. Of people with depression at the first assessment, between 13% 18 and 52% 19 still had depression at a year.…”

Literature and Art Therapy in Post-Stroke Psychological Disorders

“…In its initial phase, depression is usually related to biological changes, but depression that occurs later is often related to social functions (Robinson 2003). Therefore, emotional disorders such as depression and anxiety that appear after stroke must be dealt with effectively to help with rehabilitation (Aström et al 1993). Literature treatment is an auxiliary tool that treats neurosis as well as emotional or behavioral disorders; thus, it might be an effective therapy method for PSD as well (Jacobs and Mosco 2011;Eum et al 2014).…”