Depression after stroke or poststroke depression (PSD) has a negative impact on the rehabilitation process and the associated rehabilitation outcome. Consequently, defining risk factors for development of PSD is important. The relationship between stroke and depression is described extensively in the available literature, but the results are inconsistent. The aim of this systematic review is to outline conflicting evidence on risk factors for PSD.
Methods:
PubMed, Medline, and Web of Knowledge were searched using the keywords “stroke,” “depression,” and “risk factor” for articles published between January 01, 1995, and September 30, 2012. Additional articles were identified and obtained from a hand search in related articles and reference lists.
Results:
A total of 66 article abstracts were identified by the search strategy and 24 articles were eligible for inclusion based on predefined quality criteria. The methodology varies greatly between the various studies, which is probably responsible for major differences in risk factors for PSD reported in the literature. The most frequently cited risk factors for PSD in the literature are sex (female), history of depression, stroke severity, functional impairments or level of handicap, level of independence, and family and social support.
Conclusions:
Many risk factors are investigated over the last 2 decades and large controversy exists concerning risk factors for development of PSD. These contradictions may largely be reduced to major differences in clinical data, study population, and methodology, which underline the need for more synchronized studies.
HackeW. European Stroke Initiative Recommendations for Stroke Management - Update 2003. Cerebrovasc Dis. 2003;16:311–337.
2.
SudlowCLWarlowCP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. Stroke. 1997;28(3):491–499.
3.
MacDonaldBKCockerellOCSanderJWShorvonSD. The incidence and lifetime prevalence of neurological disorders in a prospective community based study in the UK. Brain. 2000;123(pt 4):665–676.
4.
BonitaR. Epidemiology of stroke. Lancet. 1992;339(8789):342–344.
5.
LalouxP, Belgian Stroke Council. Cost of acute stroke: a review. Acta Neurol Belg. 2003;103(2):71–77.
6.
Lloyd-JonesDAdamsRCarnethonM. Heart disease and stroke statistics—2009 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation. 2009;119(3):480–486.
7.
WolfeCD. The impact of stroke. Br Med Bull. 2000;56(2):275–286.
8.
TruelsenTBeggSMathersCDSatohT. Global Burden of Cerebrovascular Disease in the Year 2000. Geneva: World Health Organization; 2002.
9.
RotwellPMCoullAJSilverLE. Population-based study of event-rate case fatality, and mortality for all acute vascular events in all arterial territories (Oxford vascular study). Lancet. 2005;366(9499):1773–1783.
AbenIVerheyFHoningLodder JLousbergRMaesM. Research into the specificity of depression after stroke: a review on an unresolved issue. Prog Neuropsychopharmacol Biol Psychiatry. 2001;25(4):671–689.
12.
TerroniLSobreiroMConfortoAB. Association among depression, cognitive impairment and executive dysfunction after stroke. Dement Neuropsychol. 2012;6(3):152–157.
13.
NaessHNylandHIThomassenLAarsethJMyhrKM. Mild depression in young adults with cerebral infarction at long-term follow-up: a population-based study. Eur J Neurol. 2005;12(3):194–198.
14.
KotilaMNumminenHWaltimoOKasteM. Post-stroke depression and functional recovery in a population-based stroke register. The Finnstroke study. Eur J Neurol. 1999;6(3):309–312.
15.
WilliamsLSGhoseSSSwindleRW. Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry. 2004;161(6):1090–1095.
16.
WilliamsLSKroenkeKBakasT. Care management of poststroke depression: a randomized controlled trial. Stroke. 2007;38(3):998–1003.
17.
GainottiGAntonucciGMarraCPaolucciS. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry. 2001;71(2):258–261.
18.
SturmJWDonnanGADeweyHM. Quality of life after stroke—The North East Melbourne stroke incidence study (NEMESIS). Stroke. 2004;35(10):2340–2345.
19.
AndersonRJFreelandKEClouseRELustmanPJ. The prevalence of co-morbidity and depression in adults with diabetes: a meta-analyses. Diabetes Care. 2001;24(6):1069–1078.
20.
AngelelliPPaolucciPBivonaS. Development of neuropsychiatric symptoms in poststroke patients: a cross-sectional study. Acta Psychiatr Scand. 2004;110(1):55–63.
BrownCHassonHThyseliusVAlmborgAH. Post-stroke depression and functional independence: a conundrum. Acta Neurol Scand. 2012;126(1):45–51.
23.
FarnerLWagleJEngedalKFlekkøyKMWyllerTBFureB. Depressive symptoms in stroke patients: A 13 month follow-up study of patients referred to a rehabilitation unit. J Affect Disord. 2010;217(1-3):211–218.
24.
AyerbeLAyisSRuddAGHeuschmannPUWolfeCD. Natural history, predictors and associations of depression 5 years after stroke: the South London stroke register. Stroke. 2011;42(7):1907–1911.
25.
TangWKChenYKLuJY. Cerebral microbleeds and depression in lacunar stroke. Stroke. 2011;42(9):2443–2446.
26.
SchepersVPostMVisser-MeilyAVan De PortIAkhmouchMLindemanE. Prediction of depressive symptoms up to three years post-stroke. J Rehabil Med. 2009;41(11):930–935.
27.
SnaphaanLVan Der WerfSKanselaarKDe LeeuwFE. Post-stroke depressive symptoms are associated with post-stroke characteristics. Cerebrovasc Dis. 2009;28(6):551–557.
28.
BrodatyHWithhallAAltendorfASachdevPS. Rates of depression at 3 and 15 months poststroke and their relationship with cognitive decline: the Sydney stroke study. Am J Geriatr Psychiatry. 2007;15(6):477–486.
29.
LindénTBlomstrandCSkoogI. Depressive disorders after 20 months in elderly stroke patients: a case–control study. Stroke. 2007;38(6):1860–1863.
30.
SitJWWongTKClintonMLiLS. Associated factors of post-stroke depression among Hong Kong Chinese: a longitudinal study. Psychol Health Med. 2007;12(2):117–125.
31.
Van De PortIKwakkelGBruinMLindemanE. Determinants of depression in chronic stroke: a prospective cohort study. Disabil Rehabil. 2007;29(5):353–358.
32.
LeentjensAFAbenILodderJVerheyFR. General and disease-specific risk factors for depression after ischemic stroke: a two-step Cox regression analysis. Int Psychogeriatr. 2006;18(4):739–748.
33.
PaolucciSGandolfoCProvincialiLTortaRTosoV. The Italian multicenter observational study on post-stroke depression (DESTRO). J Neurol. 2006;253(5):556–562.
34.
StororDLByrneGJ. Pre-morbid personality and depression following stroke. Int Psychogeriatr. 2006;18(3):457–469.
35.
AbenILodderJHonigALousbergRBoreasAVerheyF. Focal or generalized vascular brain damage and vulnerability to depression after stroke: a 1 year prospective follow-up study. Int Psychogeriatr. 2006;18(1):19–35.
36.
CarotaABerneyAAybekS. A prospective study of predictors of poststroke depression. Neurology. 2005;64(3):428–433.
37.
TangWKChanSSChiuHF. Poststroke depression in Chinese patients: frequency, psychosocial, clinical and radiological determinants. J Geriatr Psychiatry Neurol. 2005;18(1):45–51.
38.
BergAPalomäkiHLehtihalmesMLönnqvistJKasteM. Poststroke depression: an 18 month follow-up. Stroke. 2003;34(1):138–143.
39.
AbenIDenolletJLousbergRVerheyFWojciechowskiFHonigA. Personality and vulnerability to depression in stroke patients: a 1-year prospective follow-up study. Stroke. 2002;33(10):2391–2395.
40.
BergAPalomäkiHLehtihalmesMLönnqvistJKasteM. Poststroke depression in acute phase of stroke. Cerebrovasc Dis. 2001;12(1):14–20.
41.
KauhanenMLKorpelainenJTHiltunenP. Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke. 1999;30(9):1875–1880.
42.
KotilaMNumminenHWaltimoOKasteM. Depression after stroke: results of The FINNSTROKE study. Stoke. 1998;29(2):368–372.
43.
PohjasvaaraTLeppävuoriASiiraIVatajaRKasteMErkinjunttiT. Frequency and clinical determinants of poststroke depression. Stroke. 1998;29(11):2311–2317.
44.
BurvillPJohnsonGJamrozikKAndersonCStewart-WynneE. Risk factors for post-stroke depression. Int J Geriatr Psychiatry. 1997;12(2):219–226.
45.
AndersenGVestergaardKIngemann-nielsenMLauritzenL. Risk factors for post-stroke depression. Acta Psychiatr Scand. 1995;92(3):193–198.
46.
DanielKWolfeCDBushMAMcKevittC. What are the social consequences of stroke for working-aged adults? A systematic review. Stroke. 2009;40(6):431–440.
47.
JohnsonJLMinarikPANyströmKVBautistaCGormanMJ. Poststroke depression incidence and risk factors: an integrative literature review. J Neurosci Nurs. 2006;38(4 suppl):316–327.
48.
TosoVGandolfoCPaolucciSProvincialiLTortaRGrassivaroN. Post-stroke depression: research methodology of a large multicentre observational study (DESTRO). Neurol Sci. 2004;25(3):138–144.
49.
CarsonAJMacHaleSAllenK. Depression after stroke and lesion location: a systematic review. Lancet. 2000;356(9224):122–126.
50.
NarushimaKKosierJTRobinsonRG. A reappraisal of poststroke depression, intra- and inter-hemispheric lesion location using meta-analysis. J Neuropsychiatry Clin Neurosci. 2003;15(4):422–430.
51.
RobinsonRGKubosKLStarrLBRaoKPriceTR. Mood changes in stroke patients: relationship to lesion location. Compr Psychiatry. 1983;24(6):555–566.
52.
ShimodaKRobinsonRG. The relationship between poststroke depression and lesion location in long-term follow-up. Biol Psychiatry. 1999;45(2):187–192.
53.
HerrmannLLLe MasurierMEbmeierKP. White matter hyperintensities in late life depression: a systematic review. J Neurol Neurosurg Psychiatry. 2008;79(6):619–624.
54.
SneedJRRindskopfDSteffensDCKrishnanKRRooseSP. The vascular depression subtype: evidence of internal validity. Biol Psychiatry. 2008;64(6):491–497.
HacketMLAndersonCS. Predictors of depression after stroke: a systematic review of observational studies. Stroke. 2005;36(10):2296–2301.
57.
TeronniLSobreiroMConfortoAGuajardoVde LuciaMCFraguasR. Association among depression, cognitive impairment and executive dysfunction after stroke. Dement Neuropsychol. 2012;6(3):152–157.
58.
KatonaCLivingstonG. Impact on screening old people with physical illness for depression. Lancet. 2000;356(9224):91–92.
59.
World Health Organization. The World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva: World Health Organization; 2001.
60.
BeekmanATCopelandJRPrinceMJ. Review of community prevalence of depression in later life. Br J Psychiatry. 1999;174:307–311.
61.
ParadisoSRobinsonRG. Sex differences in poststroke depression. J Neuropsychiatr Clin Neurosci. 1998;10(1):41–47.
62.
RobinsonRGKubosKLStarrLBRaoKPriceTR. Mood changes in stroke patients: relationship to lesion location. Compr Psychiatry. 1983;24(6):556–566.
63.
VerdelhoAHénsonHLebertFPasquierFLeysD. Depressive symptoms after stroke and relationship with dementia: a three year follow-up study. Neurology. 2004;62(6):905–911.
64.
StewartRPriceMMannARichardsMBrayneC. Stroke, vascular risk factors and depression: cross-sectional study in a UK Caribbean-born population. Br J Psychiatry. 2001;178(1):23–28.
65.
Boden-AlbalaBLitwakEElkindMSRundekTSaccoRL. Social isolation and outcome post stroke. Neurology. 2005;64(11):1888–1892.
66.
TomakaJThompsonSPalaciosR. The relation of social isolation, loneliness and social support to disease outcomes among the elderly. J Aging Health. 2006;18(3):359–384.
67.
RobinsonRGMurataYShimodaK. Dimensions of social impairment and their effect on depression and recovery following stroke. Int Psychogeriatr. 1999;11(4):375–384.
68.
Tsouna-HadjisEVemmosKNZakopoulosNStamatelopoulosS. First-stroke recovery process: the role of family social support. Arch Phys Med Rehabil. 2000;81(7):881–887.
69.
EvansRLMatlockALBishopDSStranahanSPedersonC. Family intervention after stroke: does counselling or education help?Stroke. 1988;19(10):1243–1249.
70.
ForsterAYoungJ. Specialist nurse support for patients with stroke in the community: a randomised controlled trial. Br Med J. 1996;312(7047):1642–1646.
