Early poststroke depression predicts long-term disability
MedWire News: Patients who develop depression 1 week after suffering a stroke are at high risk for being severely disabled 2 years later, show findings from the Northern Manhattan Stroke Study (NOMASS).
Being depressed at 7 to 10 days after stroke did not predict later mortality, however.
Depressed mood was detected in 139 (41%) of 340 stroke patients in the population-based NOMASS, and was defined purely by the first question on the Hamilton Depression Rating Scale.
"We find it noteworthy that a single question about mood would have such predictive value with the understanding that patients with stroke have undergone a potentially life-changing event and any depressive symptoms could be reactive in nature," say Joshua Willey (Columbia University, New York, USA) and colleagues in the journal Stroke.
They note: "Regardless of cause, the presence of a depressed mood may lead to diminished motivation to perform rehabilitation or to participate in medical management for secondary stroke prevention."
After 1 year of follow-up, severe disability (Barthel Index <60) was present in 21.0% versus 12.6% of patients with and without depression; the corresponding rates at 2 years were 23.6% versus 13.6%.
This equates to a 2.91-fold increase in the risk for severe disability in depressed versus nondepressed patients at 1 year and a 3.72-fold increase 2 years later, independent of variables including sociodemographic factors, stroke severity, and comorbidities.
Although the associations persisted after accounting for stroke severity, the team notes that this was the strongest mediator, "highlighting the importance of the initial deficit on ultimate outcome."
Depression did not predict death from any cause or from vascular or nonvascular causes.
"It is likely that early treatment, which may include a combination of psychosocial intervention, psychotherapy, and pharmacotherapy, is beneficial for stroke recovery, but a clinical trial is needed in the acute setting," conclude Willey et al.
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By Eleanor McDermid