Post-stroke depression: Prevalence, associated factors and impact on quality of life among outpatients in a Nigerian hospital

Abstract

ObjectivesTo investigate the prevalence of post-stroke depression (PSD), its associated factors and impact on quality of life (QoL) among outpatients in a Nigerian hospital.MethodsThis cross-sectional study was carried out among 140 adults made up of 70 stroke survivors and matched controls with stable hypertension. Participants were administered questionnaires to profile their socio-demographic and clinical characteristics. Subsequently, they were assessed with the modified mini-mental state examination (MMSE), modified Rankin Scale (mRS), schedule for clinical assessment in neuropsychiatry (SCAN) and World Health Organization Quality of Life-BREF (WHOQoL-BREF).ResultsThe mean ages (± s.d.) of stroke survivors and controls were 57.43 (± 9.67) years and 57.33 (± 9.33) years, respectively. Majority of stroke survivors (n = 55 [78.6%]) had infarctive stroke, and 37 (52.9%) had right hemispheric lesion. Sixteen (22.9%) stroke survivors had PSD, with moderate to severe depression (F32.1) being the most prevalent, while none of the controls was clinically depressed. PSD correlated positively with monthly health bill above 10 000 naira ($61), significant post-stroke disability and poorer scores on all QoL domains (p < 0.05).ConclusionDepression was 20-fold prevalent in stroke survivors compared to controls with stable hypertension, and sevenfold the life-time prevalence reported among adult general population in Nigeria. Furthermore, increased health care bills per month, significant post-stroke disability and poorer QoL indicated survivors more likely to have depression. Findings in this study support the need to pay closer attention to psychosocial needs of stroke survivors to improve well-being. Future longitudinal study on psychosocial burden of stroke is warranted.

Prevalence and correlates of depression among Nigerian stroke survivors

“…8 Prevalence of post-stroke depression (PSD) from studies worldwide varies from 9% to 53%, 9,10,11 while Nigerian studies of PSD also have rates varying from 16.2% to 52.9%. 12,13,14,15,16,17,18,19,20,21,22 Post-stroke depression has profound effects on the lives of both survivors and caregivers. 23…”

Post Stroke Depression

“…There has been some debate about the etiology of poststroke depression, where multiple hypotheses exist, including but not limited to disruption to monoamine pathways, inflammatory cytokines, and hypothalamic-pituitary axis within the brain that modulates mood. The other belief is based on a psychosocial model, where depression develops after a stroke due to inability to adjust to new life circumstances, inability to care for oneself, fear of recurrence, financial insecurity and carrying a new diagnosis [7].…”

“…Small changes like irritability, frustration, extreme fatiguability, and refusing to partake in physical therapy and occupational therapy. Another challenge is that many symptoms of stroke and depression overlap, such as fatigue, pain, decreased motor activity, and decreased verbal output [7]. Only a few of the depression scales used to assess poststroke depression include somatic symptoms in their evaluation.…”

“…In multiple studies that adjusted for pre-stroke depression it was found that more than 30% of the patients younger than 65 could be diagnosed as having clinical depression using the Center for Epidemiologic Studies Depression Scale (CES-D). It was found that within this younger age group there was a higher rate of depression associated with lower socioeconomic status, familial stress, and the ability to provide financial stability [7,11]. However, having good social support has been found to be protective against poststroke depression [7,11].…”

“…It was found that within this younger age group there was a higher rate of depression associated with lower socioeconomic status, familial stress, and the ability to provide financial stability [7,11]. However, having good social support has been found to be protective against poststroke depression [7,11]. Adults over the age of 65 represent the majority of stroke patients, which can skew the data.…”