Poststroke depression and treatment effects on functional outcomes
Abstract
Background:
Poststroke depression (PSD) is common after stroke; however, the relationship to poststroke function is inconclusive. Our objectives were to 1) determine the relationship between PSD at baseline (1 month poststroke) and function (12 weeks later) and 2) assess the impact of depression improvement on 12-week function among those with depression at baseline.
Methods:
We completed a secondary analysis of data from a cohort study of participants with and without PSD. We used logistic regression to identify factors associated with 12-week functional dependence for 1) all 367 participants and 2) the 174 participants with PSD.
Results:
In the PSD cohort, 3 characteristics were found to be independently associated with 12-week dependence: increased medical comorbidity (odds ratio [OR] 1.10, 95%confidence interval [CI] 1.02–1.22), increased stroke severity (OR 1.42, 95% CI 1.19–1.69), and increased baseline depression severity (OR 1.13, 95% CI 1.03–1.23). Depression severity was significantly different between those considered dependent and independent at 12 weeks (entire cohort, PHQ-9 7.31 vs 5.18, p = 0.008; depressed cohort, PHQ-9 9.94 vs 7.27, p = 0.019).
Conclusion:
Among study participants with PSD, the severity of depression symptoms at baseline was associated with dependence; however, our results are inconclusive as to whether improvement of depression is independently associated with functional recovery at 12 weeks. Even if the treatment and improvement of PSD does not directly influence functional recovery poststroke, it is essential for PSD to be identified and treated due to its high symptom burden and association with other negative health and social outcomes.
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REFERENCES
1.
Lloyd-Jones D, Adams RJ, Brown TM, et al. on behalf of the American Heart Association Statistics C, Stroke Statistics S. Heart disease and stroke statistics: 2010 update: a report from the American Heart Association. Circulation 2010;121:e46–e215
2.
Andersen G, Vestergaard K, Riis J, Lauritzen L. Incidence of post-stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale. Acta Psychiatr Scand 1994;90:190–195
3.
Bilge C, Kocer E, Kocer A, Turk Boru U. Depression and functional outcome after stroke: The effect of antidepressant therapy on functional recovery. Eur J Phys Rehabil Med 2008;44:13–18
4.
Paolucci S, Antonucci G, Pratesi L, Traballesi M, Grasso MG, Lubich S. Poststroke depression and its role in rehabilitation of inpatients. Arch Phys Med Rehabil 1999;80:985–990
5.
Everson SA, Roberts RE, Goldberg DE, Kaplan GA. Depressive symptoms and increased risk of stroke mortality over a 29-year period. Arch Intern Med 1998;158:1133–1138
6.
Schubert DS, Burns R, Paras W, Sioson E. Increase of medical hospital length of stay by depression in stroke and amputation patients: a pilot study. Psychother Psychosom 1992;57:61–66
7.
Williams LS, Ghose SS, Swindle RW. Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry 2004;161:1090–1095
8.
Ramasubbu R, Robinson RG, Flint AJ, Kosier T, Price TR. Functional impairment associated with acute poststroke depression: the Stroke Data Bank Study. J Neuropsychiatry Clin Neurosci 1998;10:26–33
9.
Lai SM, Duncan PW, Keighley J, Johnson D. Depressive symptoms and independence in BADL and IADL. J Rehabil Res Dev 2002;39:589–596
10.
Hackett ML, Anderson CS, House A, Xia J. Interventions for treating depression after stroke. Cochrane Database Syst Rev 2008;CD003437
11.
Williams LS, Kroenke K, Bakas T, et al. Care management of poststroke depression: a randomized, controlled trial. Stroke 2007;38:998–1003
12.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198
13.
Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968;16:622–626
14.
Spitzer RL, Williams JB, Gibbon M. Instruction Manual for the Structured Clinical Interview for DSM-III-R. New York: Biometrics Research Development, New York State Psychiatric Institute; 1986
15.
Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID): I: history, rationale, and description. Arch Gen Psychiatry 1992;49:624–629
16.
Williams LS, Brizendine EJ, Plue L, et al. Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke 2005;36:635–638
17.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–613
18.
Rankin J. Cerebral vascular accidents in patients over the age of 60: II: prognosis. Scott Med J 1957;2:200–215
19.
Sulter G, Steen C, Jacques De K. Use of the Barthel index and modified Rankin Scale in acute stroke trials. Stroke 1999;30:1538–1541
20.
Brott T, Adams HP, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–870
21.
Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH Stroke Scale. Stroke 2000;31:858–862
22.
Whyte EM, Mulsant BH, Vanderbilt J, Dodge HH, Ganguli M. Depression after stroke: a prospective epidemiological study. J Am Geriatr Soc 2004;52:774–778
23.
Saxena SK, Ng TP, Koh G, Yong D, Fong NP. Is improvement in impaired cognition and depressive symptoms in post-stroke patients associated with recovery in activities of daily living? Acta Neurol Scand 2007;115:339–346
24.
Hama S, Yamashita H, Shigenobu M, et al. Depression or apathy and functional recovery after stroke. Int J Geriatr Psychiatry 2007;22:1046–1051
25.
Fruehwald S, Gatterbauer E, Rehak P, Baumhackl U. Early fluoxetine treatment of post-stroke depression: a three-month double-blind placebo-controlled study with an open-label long-term follow up. J Neurology 2003;250:347–351
26.
Jorge RE, Acion L, Moser D, Adams HP, Robinson RG. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010;67:187–196
27.
Chemerinski E, Robinson RG, Arndt S, Kosier JT. The effect of remission of poststroke depression on activities of daily living in a double-blind randomized treatment study. J Nerv Ment Dis 2001;189:421–425
28.
Chemerinski E, Robinson RG, Kosier JT. Improved recovery in activities of daily living associated with remission of poststroke depression. Stroke 2001;32:113–117
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Copyright © 2011 by AAN Enterprises, Inc.
Publication History
Received: March 2, 2010
Accepted: November 24, 2010
Published online: March 14, 2011
Published in print: March 15, 2011
Disclosure
Dr. Schmid receives research support from the US Veterans Administration. Dr. Kroenke serves on scientific advisory boards for Eli Lilly & Company and Forest Laboratories, Inc.; has received funding for travel and speaker honoraria from Eli Lilly & Company, Forest Laboratories, Inc., and Pfizer Inc.; serves on the editorial boards of Archives of Internal Medicine, General Hospital Psychiatry, Psychosomatics, and Journal of Clinical Psychiatry Primary Care Companion; receives research support from Eli Lilly & Company, the NIH (NIMH and NCI), and the US Veterans Administration; and has served as a consultant for Ohio State University, University of Illinois, and Cambridge Hospital. Dr. Hendrie reports no disclosures. Dr. Bakas serves on the advisory board of the American Stroke Association Advisory Board and receives research support from the NIH (NINDS, NINR). Dr. Sutherland reports no disclosures. Dr. Williams serves as Health Policy and Outcomes Section Co-chair for Stroke and receives research support from the US Veterans Administration.
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Statistical analysis was conducted by Dr. Sutherland.
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