Long‐Term Course of Depression After Stroke and Risk Factors for Symptoms With Poor Progression: A Population‐Based Study
Lu Liu, Iain Marshall, Ajay Bhalla, Xianqi Li, Salma Ayis, Charles Wolfe, Yanzhong Wang, Matthew O’Connell
Abstract
BACKGROUND: Data on the long-term poststroke depression trajectories and their determinants are limited. This study aims to estimate the 5-year course of poststroke depression and identify risk factors for recurrent and persistent depression. METHODS: Data were from the South London Stroke Register (1997-2022). Depression was defined as a subscale score >7 on the Hospital Anxiety and Depression Scale at 3 months and annually up to 5 years. Participants with >2 assessments of depression were included. Multinomial logistic regression examined associations between baseline factors, changes in function, and recurrent or persistent depression. RESULTS: The analysis comprised 1724 participants (mean age, 65.5 years; men, 55.9%, White race, 65.2%). Of these, 1067 (61.9%) were not depressed at any time point. Among those with depression at some time point, 125 (19.0%) had transient depression, 231 (35.2%) had recurrent depression, and 301 (45.8%) had persistent depression. Patients with moderate to severe stroke (adjusted odds ratio, 1.81 [95% CI, 1.25-2.61]) or physical disability (adjusted odds ratio, 1.59 [95% CI, 1.12-2.26]) were more likely to develop recurrent depression, while patients with cognitive impairment (adjusted odds ratio, 2.09 [95% CI, 1.44-3.05]) or prestroke depression (adjusted odds ratio, 2.67 [95% CI, 1.60-4.47]) were at increased likelihood of having persistent depression. Patients exhibiting a decline in physical ability at 3 months were more likely to experience depression with poor progression (recurrent or persistent depression), independent of the initial severity of physical disability. CONCLUSIONS: Recurrent depression was associated with moderate to severe stroke or disability, whereas persistent depression was linked to prestroke depression or cognitive impairment. Progressive worsening disability was associated with recurrent or persistent depression, regardless of initial severity.