Post-stroke depression contributes to functional dependency risk
MedWire News: Increased severity of depressive symptoms in patients who develop the condition following a stroke reduces the likelihood of them achieving functional independence, research suggests.
The researchers note that their study cannot prove that early treatment of post-stroke depression (PSD) would improve functional outcomes.
But lead study author Arlene Schmid (Roudebush Veterans Administration Medical Center, Indianapolis, USA) stressed that a third of stroke survivors develop PSD.
"Even if the treatment and improvement of PSD does not directly influence recovery, it is extremely important for depression to be identified and treated, since it is associated with other health and social problems," she said.
The current study, which appears in the journal Neurology, included 174 patients with PSD and 367 without. PSD was identified at 1-2 months after stroke using the Patient Health Questionnaire (PHQ-9), and formally diagnosed with the Structured Clinical Interview for Depression.
Overall, the existence of depression at baseline did not affect patients' risk for functional dependence at 12 weeks (modified Rankin Scale 3-5). However, among patients with depression, baseline PHQ-9 scores were 15.80 in patients who were dependent versus 13.89 in those who were independent.
This difference remained significant on multivariate analysis, with stroke severity and medical comorbidity also contributing to the risk for functional dependency. Average Cormorbidity Index Rating Scale scores were 16.58 versus 13.99 in dependent and independent patients, respectively, while National Institutes of Health Stroke Scale scores were 3.58 versus 2.04.
At 12 weeks, depressed patients who were functionally dependent scored an average of 9.94 on the PHQ-9, compared with 7.27 among those who were independent. The corresponding scores in the entire cohort were 7.31 versus 5.18.
"Further research exploring whether PSD treatment is related to functional recovery in a more heterogeneous and larger group of stroke survivors is necessary to help identify other mechanisms to improve stroke survivors' outcomes," concludes the team.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid