Stroke,Depression,and Functional Health Outcomes Among Adults in the Community

Abstract

The objective was to determine the association between stroke and depression, the co-occurrence of stroke and depression, and functional health outcomes among adults in the US population. Data were drawn from the Midlife Development in the United States Study (MIDUS) (N = 3032), a nationally representative sample of adults age 25 to 74. Multiple logistic regression analyses were used to determine the association between stroke (past 12-month prevalence), depression (past 12-month prevalence), and functional health outcomes (past 12 months) and to determine whether there is an interaction between depression and stroke in predicting impairment in functioning. Almost one third (29.2%) of adults with stroke in the past year also had depression in the past year (odds ratio 3.5, 95% confidence interval 1.4, 8.9). The co-occurrence of stroke and depression was associated with significantly greater limitations in walking and climbing stairs and poorer general physical functioning than that associated with either without the other. There was evidence of interaction between depression and stroke in predicting limitations, specifically with a statistically significant effect in walking short distances (P = .045). These findings are consistent with previous clinical data and extend those data by suggesting that the co-occurrence of depression and stroke is associated with even poorer functional health outcomes, compared with each alone, and that there may be synergism between the two disorders related to this effect.

Keywords

stroke epidemiology major depression functioning

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References

Dhoudt T. , Derksen P. , Hooijer C. , et al. Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people . Int J Geriatr Psychiatry. 1999;14:878-881.

Sato R. , Bryan RN , Fried LP Neuroanatomic and functional correlates of depressed mood: the Cardiovascular Health Study. Am J Epidemiol. 1999;150:919-929.

Carson AJ , MacHale S. , Allen K. , et al. Depression after stroke and lesion location: a systematic review . Lancet. 2000;356:122-126.

Goonick PJ , Hernandez M. Treatment of depression in comorbid medical illness. Expert Opin Pharmacother. 2000;1:1367-1384.

Berg A. , Palomaki H. , Lentihalmes H. , Lonnqvist J. , Kaste M. Poststroke depression in acute phase after stroke. Cerebrovasc Dis. 2001;1:14-20.

Alexopoulos GS , Kiosses DN , Klimstra S. , Kalayam B. , Bruce ML Clinical presentation of the “depressionexecutive dysfunction syndrome” of late life. Am J Geriatr Psychiatry . 2002;10:98-106.

Hawkins BT , Brown RC , Davis TP Smoking and ischaemic stroke: a role for nicotine? Trends Pharmacol Sci. 2002;23:78-82.

Hamalainen J. , Kapico J. , Isometsa E. , et al. Cigarette smoking, alcohol intoxication, and major depressive episode in a representative population sample. J Epidemiol Comm Health. 2001;55:573-576.

Yamashita H. , Fujikawa T. , Yanai L. , Morinobu S. , Yamanaki S. Cognitive dysfunction in recovered depressed patients with silent cerebral infarction. Neuropsychobiology . 2002; 45:12-18.

10.

Ramasubbu S. Psychological models of post-stroke major depression . Br J Psychiatry. 2000;176:294-296.

11.

Kauhanen ML , Korpelainen JT , Hiltunen P. , et al. Aphasia, depression, and nonverbal cognitive impairment in ischaemic stroke. Cerebrovasc Dis . 2000;10:455-461.

12.

House A. , Knapp P. , Bamford J. , Vail A. Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke. 2001;32:696-701.

13.

Dam H. Depression in stroke patients 7 years following stroke. Acta Psychiatr Scand. 2001;103:287-293.

14.

Morris PL , Shields RB , Hopwood MJ , Robinson RG , Raphael B.

Are there two depressive syndromes after stroke?

J Nerv Ment Dis. 1994;182:230-234.

15.

Vataja R. , Pohjasvaara T. , Leppavuori A. , et al. Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychol. 2001;58:925-931.

16.

Dundas R. , Morgan M. , Redfern J. , Lemic-Stojcevic N. , Wolfe C. Ethnic differences in behavioural risk factors for stroke: implications for health promotion. Ethn Health. 2001;6:95-103.

17.

Brim OG , Baltes PB , Bumpass LL , et al. National Survey of Midlife Development in the United States (MIDUS). Ann Arbor, Mich: Inter-university Consortium for Political and Social Research; 1995-96.

18.

Kessler RC , DuPont RL , Berglund P. , Wittchen HU Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry. 1999;156:1915-1923.

19.

Kessler RC , Mickelson KD , Zhao S. Patterns and correlates of self-help group membership in the United States . Soc Policy. 1997;27:27-46.

20.

Kessler RC , McGonagle KA , Zhao S. , et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8-19.

21.

Wittchen HU Reliability and validity studies of the WHO Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res. 1994;28:57-84.

22.

Kessler RC , Andrews G. , Mroczek D. , Ustun B. , Wittchen H-U. The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF). Int J Methods Psychiatr Res. 1998;7:171-185.

23.

Astrom M. Generalized anxiety disorder in stroke patients: a 3-year longitudinal study . Stroke. 1996;27:270-275.

24.

Zetola VH , Novak EM , Camargo CH , et al. Stroke in young adults: analysis of 164 patients. Arq Neuropsiquiatr. 2001;59:740-745.

25.

Steffen DC , Payne MG , Greenberg DL , et al. Hippocampal volume and incident dementia in geriatric depression . Am J Geriatr Psychiatry. 2002;10:62-71.

26.

Downhill JE Jr , Robinson RG Longitudinal assessment of depression and cognitive impairment following stroke. J Nerv Ment Dis. 1994;182:425-431.

27.

Kubota M. , Yamaura A. , Ono J. Prevalence of risk factors for aneurysmal subarachnoid haemorrhage: results of a Japanese multicentre case control study for stroke. Br J Neurosurg. 2001;15:474-478.

28.

Mazzaglia G. , Britton AR , Altmann DR , Chenet L. Exploring the relationship between alcohol consumption and non-fatal or fatal stroke: a systematic review. Addiction. 2001;96:1743-1756.

29.

Ruitenberg A. , van Swieten JC , Witteman JC , et al. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet. 2002;359:281-286.

30.

Mazzaglia G. , Britton AR , Altmann DR , Chenet L. Exploring the relationship between alcohol consumption and non-fatal or fatal stroke: a systematic review. Addiction. 2001;96:1743-1756.

31.

Scheier MF , Matthews KA , Owens JF , et al. Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med. 1999;26:829-835.

32.

Clark MS , Smith DS Psychological correlates of outcome following rehabilitation from stroke. Clin Rehabil. 1999;13:129-140.

33.

Aben I. , Verhey F. , Honig A. , Codder J. , Lobisberg R. , Maes M. Research into the specificity of depression after stroke: a review on an unresolved issue. Prog Neuropsychopharmacol Biol Psychiatry. 2001;25:671-689.

34.

Staub F. , Bogonsslavsky J. Fatigue after stroke: a major but neglected issue. Cerebrovasc Dis. 2001;12:75-81.

35.

Gainotti G. , Antonucci G. , Marra C. , Paolucci S. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry. 2001;71:258-261.