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      The Correlates and Course of Depression in Patients with Lacunar Stroke: Results from the Secondary Prevention of Small Subcortical Strokes (SPS3) Study

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          Abstract

          Background: Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability. Methods: Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject. Results: The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96–0.99), male gender (OR 0.62; 95% CI 0.48–0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98–1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3–2.4), living with a spouse/family (OR 1.6; 95% CI 1.1–2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0–1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06–1.17) for each 1-year increase in time. Conclusions: One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.

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          Frequency of depression after stroke: a systematic review of observational studies.

          Maree Hackett, Chaturangi M Yapa, Varsha Parag … (2005)
          Although depression is an important sequelae of stroke, there is uncertainty regarding its frequency and outcome. We undertook a systematic review of all published nonexperimental studies (to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke. Data were available from 51 studies (reported in 96 publications) conducted between 1977 and 2002. Although frequencies varied considerably across studies, the pooled estimate was 33% (95% confidence interval, 29% to 36%) of all stroke survivors experiencing depression. Differences in case mix and method of mood assessment could explain some of the variation in estimates across studies. The data also suggest that depression resolves spontaneously within several months of onset in the majority of stroke survivors, with few receiving any specific antidepressant therapy or active management. Depression is common among stroke patients, with the risks of occurrence being similar for the early, medium, and late stages of stroke recovery. There is a pressing need for further research to improve clinical practice in this area of stroke care.
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            Predictors of depression after stroke: a systematic review of observational studies.

            Michael Anderson, Maree Hackett (2005)
            Although depression is common after stroke, there is uncertainty over its etiology and risk factors, which complicates management. Knowledge of the predictors of depression associated with stroke may allow for the better targeting of therapy, both prevention and treatment. We undertook a systematic review of all published, nonexperimental, population-, hospital-, and rehabilitation-based stroke studies (to June 2004) with prospective, consecutive patient recruitment undertaken to identify variables associated with depressive symptoms (or "illness") after stroke. Assessments were made of the quality of studies including the validity of prognostic models. Data were available from 3 population-based studies including 492 patients, 8 hospital-based studies including 15,272 patients, and 9 rehabilitation-based studies including 2170 patients. Physical disability, stroke severity and cognitive impairment were consistently associated with depression. In addition to the common problem of selection bias, major limitations of these studies included variable selection and poor statistical quality and reporting; small sample sizes meant that only a limited range of variables were analyzed in multivariate models. There is a paucity of well-designed studies of sufficient size to allow stable multivariate predictive models of depression after stroke to be developed. Other than showing that depression is associated with more severe strokes, current evidence does not allow for ready identification of patients most at risk of developing this important complication of stroke.
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              The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results.

              Joanne B Farrell, J Godwin, S. Richards … (1991)
              Article 0 comments Cited 111 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): CED
                Journal ID (nlm-ta): Cerebrovasc Dis
                Journal ID (doi): 10.1159/issn.1015-9770
                Title: Cerebrovascular Diseases
                Publisher: S. Karger AG
                ISSN (Print): 1015-9770
                ISSN (Electronic): 1421-9786
                Publication date Subscription-year: 2011
                Publication date (Print): October 2011
                Publication date (Electronic): 15 September 2011
                Volume: 32
                Issue: 4
                Pages: 354-360
                Affiliations
                aSchool of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Tex., bDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala., cDepartment of Neurology, Rochester General Hospital, Rochester, N.Y., dDepartment of Neurology, Grady Hospital, Atlanta, Ga., and eMetroHealth Medical Center, Center for Health Care Research and Policy, Cleveland, Ohio, USA; fSPS3 Coordinating Center, University of British Columbia, and gDivision of Neurology, Department of Medicine, Brain Research Center, University of British Columbia, Vancouver, B.C., Canada
                Author notes
                *Carole L. White, RN, PhD, SPS3 Coordinating Center, 8300 Floyd Curl Drive – MSC 7883, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900 (USA), Tel. +1 210 567 5831, E-Mail whitec2@uthscsa.edu
                Article
                Publisher ID: 330350 Pmcid ID: PMC3712814 Other ID: Cerebrovasc Dis 2011;32:354–360
                DOI: 10.1159/000330350
                PMC ID: PMC3712814
                PubMed ID: 21921599
                SO-VID: 89c16761-079e-4570-98fa-72ec029ea35e
                Copyright © © 2011 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 15 February 2011
                Date accepted : 08 June 2011
                Page count
                Tables: 2, Pages: 7
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Keywords: Lacunar stroke,Depression after stroke,Secondary Prevention of Small Subcortical Strokes study,Predictors of outcome,Longitudinal study
                Data availability:
                ScienceOpen disciplines: Geriatric medicine, Neurology, Cardiovascular Medicine, Neurosciences, Clinical Psychology & Psychiatry, Public health
                Keywords: Lacunar stroke, Depression after stroke, Secondary Prevention of Small Subcortical Strokes study, Predictors of outcome, Longitudinal study

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