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A prospective study of predictors of poststroke depression

From the Departments of Neurology (Drs. Carota, Aybek, Ghika-Schmid, and Bogousslavsky, F. Staub) and Psychiatry (Drs. Berney and Guex), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Neuropsychology Research Center (Drs. Carota and Iaria), I.R.C.C.S, Fondazione Santa Lucia and Psychology Department, "La Sapienza" University, Rome, Italy; and Department of Psychiatry (Drs. Berney and Annable), McGill University, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Julien Bogousslavsky, Service de Neurologie, CHUV, CH-1011 Lausanne, Switzerland; e-mail: Julien.Bogousslavsky{at}chuv.hospvd.ch

Objective: To investigate the association between early depressive behavior after stroke onset and occurrence of poststroke depression (PSD) at 3- and 12-month follow-up evaluations.

Methods: The study prospectively included 273 patients with first-ever single uncomplicated ischemic stroke. In the stroke unit, nurses scored crying, overt sadness, and apathy daily using an observational method to include patients with comprehension deficits. The Barthel Index was used to assess disability. Follow-up evaluation at months 3 and 12 included psychiatric assessment based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

Results: Crying (19.8%), overt sadness (50.5%), and apathy (47.6%) were observed. Of the patients observed crying, 4 showed pathologic crying, 19 emotionalism, and 12 catastrophic reactions. Crying and overt sadness, but not apathy, were associated with a subjective experience of depression (p < 0.05). Thirty of 52 (58%) patients observed crying, 12 of 19 (63%) patients with emotionalism, and 5 of 12 (41%) patients with catastrophic reactions developed PSD within the first year. Multiple logistic regression analysis showed that only severe functional disability (odds ratio [OR], 4.31; 95% CI, 2.41 to 7.69), crying behaviors (OR, 2.66; 95% CI, 1.35 to 5.27), and an age <68 years (OR, 2.32; 95% CI, 1.30 to 4.13) were (p < 0.05) predictors of late PSD development (13% of the variance).

Conclusions: In the stroke unit, crying and overt sadness are more reliable indicators of depressed mood than apathy. In patients with first-ever stroke, crying behaviors soon after stroke, a younger age, and severe disability are predictors of poststroke depression occurrence within the first year after stroke onset.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the February 8 issue to find the title link for this article.

Supported by Swiss National Research Foundation grants (32-41950-94, 3200-050728-98, and 3200-06134200/1) and a Biaggi Foundation’s grant.

Received May 26, 2004. Accepted in final form October 15, 2004.

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