Prevalence and natural history of depression after stroke: A systematic review and meta-analysis of observational studies

Abstract

Background Depression is the most frequent psychiatric condition after stroke and is associated with negative health outcomes. We aim to undertake a systematic review and meta-analysis of the prevalence and natural history of depression after stroke. Methods and findings Studies published up to 4 November 2022 on Medline, Embase, PsycINFO, and Web of Science Core Collection were searched. We included studies of adults with stroke, where depression was assessed at a prespecified time point. Studies excluding people with aphasia and history of depression are excluded. Critical Appraisal Skills Programme(CASP) cohort study tool was used to assess risk of bias. A total of 77 studies were included in the pooled estimates of the prevalence of poststroke depression (PSD). The overall prevalence of depression was 27% (95% CI 25 to 30). Prevalence of depression was 24% (95% CI 21 to 28) by clinical interview and 29% (95% CI 25 to 32) by rating scales. Twenty-four studies with more than one assessment time point reported the natural history of PSD. Among people who were depressed within 3 months of stroke, 53% (95% CI 47 to 59) experienced persistent depression, while 44% (95% CI 38 to 50) recovered. The incidence of later depression (3 to 12 months after stroke) was 9% (95% CI 7 to 12). The cumulative incidence during 1 year after stroke was 38% (95% CI 33 to 43), and the majority (71% (95% CI 65 to 76)) of depression had onset within 3 months after stroke. The main limitation of the present study is that excluding people in source studies with severe impairments may produce imprecise estimates of the prevalence of PSD. Conclusions In this study, we observed that stroke survivors with early-onset depression (within 3 months after stroke) are at high risks for remaining depressed and make up two-thirds of the incident cases during 1 year after stroke. This highlights the need for ongoing clinical monitoring of patients depressed shortly after stroke. Trial Registration PROSPERO CRD42022314146.

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Impact of post‐stroke aphasia on functional communication, quality of life, perception of health and depression: A case–control study

“…Post‐stroke aphasia is associated with an increased mortality rate, long‐term disability and decline in quality of life (QoL) [1]. Some studies suggest that one in four post‐stroke patients eventually become depressed [2], with aphasia being identified as a major risk factor [3]. However, the actual prevalence and overall impact of depression amongst people with aphasia may be underreported in the literature due to the exclusion of patients with moderate to severe communication impairments from most studies [3].…”

“…However, the actual prevalence and overall impact of depression amongst people with aphasia may be underreported in the literature due to the exclusion of patients with moderate to severe communication impairments from most studies [3]. The reported prevalence of post‐stroke depression in systematic [3] and narrative reviews [4] is approximately 52%, which is higher than the 38% (95% confidence interval 33–43) cumulative pooled incidence of depression at 1 year after stroke in the overall stroke population [2].…”