Measures Associated With Early, Late, and Persistent Clinically Significant Symptoms of Depression 1 Year After Stroke in the AFFINITY Trial

Almeida, Osvaldo P.; Hankey, Graeme J.; Ford, Andrew H.; Etherton‐Beer, Christopher; Flicker, Leon; Hackett, Maree L.

doi:10.1212/wnl.0000000000200058

Cited by 11 publications

(16 citation statements)

References 32 publications

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“…The literature on factors influencing optimism is sparse, but studies of poststroke depression identify that the factors most associated with the development of poststroke depression are older age, stroke severity, and preexisting diagnosis of depression. 26 In evaluation of comorbidities and medical complications in this sample, there were no significant differences among groups in the total number or individual type of comorbidities and medical complications, but this interplay between mood, affect, and comorbidities in stroke may benefit from exploration in a larger data set.…”

Section: Discussionmentioning

confidence: 81%

Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke

Sloane

Kasner

Favilla

et al. 2023

JAHA

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Background Psychological health is as an important contributor to recovery after cardiovascular disease, but the roles of both optimism and depression in stroke recovery are not well characterized. Methods and Results A total of 879 participants in the SRUP (Stroke Recovery in Underserved Populations) 2005 to 2006 Study, aged ≥50 years, with incident stroke admitted to a rehabilitation facility were included. Optimism was assessed by the question: “Are you optimistic about the future?” Depression was defined by Center for Epidemiologic Studies Depression scale score >16. Participants were categorized into 4 groups: optimistic/without depression (n=581), optimistic/with depression (n=197), nonoptimistic/without depression (n=36), and nonoptimistic/with depression (n=65). Functional Independence Measure scores were used to assess stroke outcomes at discharge, 3 months after discharge, and 1 year after discharge with adjusted linear mixed models to estimate score trajectories. Participants were a mean age of 68 years (SD, 13 years), 52% were women, and 74% were White race. The optimistic/without depression group experienced the most recovery of total Functional Independence Measure scores in the first 3 months, 24.0 (95% CI, 22.5–25.4), followed by no change in the following 9 months, −0.3 (95% CI, −2.3 to 1.7), similar to the optimistic/with depression group with rapid recovery in 0 to 3 months, 21.1 (95% CI, 18.6–23.6) followed by minimal change in 3 to 12 months, 0.7 (95% CI, −2.8 to 4.1). The nonoptimistic groups demonstrated slow but continued recovery throughout the 12‐month period, with overall change, 25.4 (95% CI, 17.6–33.2) in the nonoptimistic/without depression group and 17.6 (95% CI, 12.0–23.1) in the nonoptimistic/with depression group. There was robust effect modification between optimism and depression ( P interaction <0.001). Conclusions In this longitudinal cohort, optimism and depression are synergistically associated with functional recovery after stroke. Measuring optimism status may help identify individuals at risk for worse poststroke recovery.

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Section: Discussionmentioning

confidence: 81%

Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke

Sloane

Kasner

Favilla

et al. 2023

JAHA

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“…An increased awareness of the interplay between prestroke depressive symptoms and differential functional outcomes poststroke is important when considering targeted interventions to enhance strategies for encouraging participation in poststroke rehabilitation. Antidepressant usage poststroke has not been demonstrated to benefit poststroke functional recovery, 35,36 even in secondary analysis of those with clinical depression, 37 and has the potential for harm, 32,36 so it should not be encouraged routinely. We would suggest that alternative clinical trial approaches such as targeting patients with recent depressive symptoms are needed to see if this can improve poststroke outcomes for patients.…”

Section: Discussionmentioning

confidence: 99%

Depressive Symptoms and Risk of Acute Stroke

et al. 2023

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Backgroundand ObjectivesDepression has been reported to be a risk factor for acute stroke, based largely on studies in high-income countries. In the INTERSTROKE study, we explored the contribution of depressive symptoms to acute stroke risk and 1-month outcome across regions of the world, within subpopulations and by stroke typeMethodsINTERSTROKE is an international case-control study of risk factors for first acute stroke, conducted in 32 countries. Cases were patients with CT or MRI confirmed incident acute hospitalized stroke, and controls were matched for age, sex, and within sites. Standardized questions asked about self-reported depressive symptoms during the previous 12 months and use of prescribed antidepressant medications were recorded. Multivariable conditional logistic regression was used to determine the association of pre-stroke depressive symptoms with acute stroke risk. Adjusted ordinal logistic regression was used to explore the association of pre-stroke depressive symptoms with post-stroke functional outcome, measured with the modified-Rankin scale at 1-month after stroke.ResultsOf 26,877 participants, 40.4% were women, the mean age was 61.7 ± 13.4 years. The prevalence of depressive symptoms within the last 12 months was higher in cases compared to controls (18.3%vs.14.1%,p< 0.001) and differed by region (pinteraction< 0.001), with lowest prevalence in China (6.9% in controls) and highest in South America (32.2% of controls). In multivariable analyses pre-stroke depressive symptoms were associated with greater odds of acute stroke (OR 1.46, 95%CI 1.34–1.58), which was significant for both intracerebral hemorrhage (OR 1.56, 95%CI 1.28–1.91) and ischemic stroke (OR 1.44, 95%CI 1.31–1.58). A larger magnitude of association with stroke was seen in patients with a greater burden of depressive symptoms. While pre-admission depressive symptoms were not associated with a greater odds of worse baseline stroke severity (OR 1.02, 95%CI 0.94–1.10), they were associated with a greater odds of poor functional outcome at 1-month after acute stroke (OR 1.09, 95%CI 1.01–1.19).DiscussionIn this global study we recorded that depressive symptoms are an important risk factor for acute stroke, including both ischemic and hemorrhagic stroke. Pre-admission depressive symptoms were associated with poorer functional outcome, but not baseline stroke severity, suggesting an adverse role of depressive symptoms in post-stroke recovery.

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“…Existing systematic reviews suggest that one in three stroke survivors will experience clinically significant symptoms of depression, and that the proportion of those affected does not vary much with time [4 ▪ ]. In contrast, the results of the Assessment of Fluoxetine in Stroke Recovery (AFFINITY) trial found that about 19% of 1221 participants showed evidence of clinically significant symptoms of depression at the time of recruitment 2–15 days after a mild to moderate acute stroke (either ischaemic or haemorrhagic) [5 ▪▪ ]. The study defined clinically significant symptoms of depression as a score of 9 or greater on the Patient Health Questionnaire (PHQ-9).…”

Section: Stroke and Depressionmentioning

confidence: 96%

“…The study defined clinically significant symptoms of depression as a score of 9 or greater on the Patient Health Questionnaire (PHQ-9). In addition, the proportion of those affected by clinically significant symptoms of depression decreased progressively with time to about 10% after 3 months and 8% after 6 months [5 ▪▪ ]. The results of AFFINITY also showed that although the proportion of people affected by depression decreases with time, one in three survivors experienced clinically significant symptoms at some point over a period of 12 months, and in 30% of these symptoms were present both during the sub-acute (≤ 3 months) and recovery phases (3–12 months) [6 ▪ ].…”

Section: Stroke and Depressionmentioning

confidence: 96%

Stroke, depression, and self-harm in later life

Almeida

2023

Current Opinion in Psychiatry

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Purpose of the review To examine recently published results of randomized placebo-controlled trials investigating the clinical effects of selective serotonin reuptake inhibitors on the prevalence of clinically significant symptoms of depression and suicidal ideation after an acute stroke. Recent findings The prevalence of poststroke depression varies markedly according to the approach used to define depression, with recently published data suggesting that about one in every three stroke survivors will experience clinically significant symptoms of depression over a period of 12 months. The proportion of stroke survivors with clinically significant symptoms of depression decreases progressively with time, but in 30% of them symptoms persist or recur over 12 months. Routine daily treatment with 20 mg of fluoxetine for 6 months does not affect the prevalence of depression in this population, nor is it effective at treating or preventing poststroke depressive symptoms. Treatment discontinuation, gastrointestinal adverse effects, seizures and bone fractures are more frequent among stroke survivors treated with antidepressants than placebo. Moreover, current data show that thoughts about death or suicide are more frequent among adults who had a stroke than the general population, although recurring suicidal thoughts are uncommon. Routine daily treatment with 20 mg of fluoxetine for 6 months does not change the proportion of people who disclose suicidal thoughts over a period of 12 months after an acute stroke. Summary Current evidence raises concerns about the efficacy and safety of antidepressants for the management and prevention of poststroke clinically significant symptoms of depression. It is unclear if these findings can be generalized to people with severe strokes or to stroke survivors with moderate to severe major depressive episodes.

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Measures Associated With Early, Late, and Persistent Clinically Significant Symptoms of Depression 1 Year After Stroke in the AFFINITY Trial

Cited by 11 publications

References 32 publications

Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke

Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke

Depressive Symptoms and Risk of Acute Stroke

Stroke, depression, and self-harm in later life

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