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Depression incidence 8 times higher in individuals with stroke vs. general population

Depression was common among individuals with stroke during the first year after diagnosis, particularly among those with prior depression or severe stroke.

“Depression is common after stroke, and studies have evaluated its frequency, risk factors, and mortality. However, recent systematic reviews of more than 50 cohorts have been hampered by heterogeneity across studies and small sample sizes; consequently, the reported frequency of depression after stroke has varied from 2% to 55% in population-based cohorts, with pooled estimates between 29% and 31% in recent meta-analyses,” Terese S. H. Jørgensen, MSc, of Copenhagen University, Glostrup, Denmark, and colleagues wrote.

To compare incidence and risk factors for depression among individuals with and without stroke, researchers analyzed a register-based cohort of individuals aged 15 years and older with a first-time hospitalization for stroke between 2001 and 2011 in Denmark (n = 157,243) and a reference population (n = 160,236).

Overall, depression occurred among 25.4% of individuals with stroke and 7.8% of the reference group within 2 years after study entry.

Individuals with stroke had a higher incidence of depression during the first 3 months after hospitalization (HR = 8.99; 95% CI, 8.61-9.39), compared with the reference group. This declined during the second year of follow-up (HR = 1.93; 95% CI, 1.85-2.08).

Older age, female sex, single cohabitation, basic educational attainment, diabetes, high level of somatic comorbidity and history of depression were significant risk factors for depression among all study participants. These associations were strongest in the reference groups, according to researchers.

Stroke severity was also a significant risk factor for depression among individuals with stroke.

All-cause mortality was higher among individuals with depression, particularly new-onset depression, including those with stroke (HR = 1.89; 95% CI, 1.83-1.95) and without stroke (HR = 3.75; 95% CI, 3.51-4), according to adjusted analysis.

In most models, depression-related relative mortality was approximately twice as high in the reference group vs. the stroke group.

“The Jørgensen et al study indicates the need for a reappraisal of the importance of the stroke lesion in triggering depression in the context of background predisposing factors that include old age, female sex, living alone, having limited education, a history of depression, and diabetes,” Craig S. Anderson, MD, PhD, of the George Institute for Global Health, Camperdown, Australia, wrote in an accompanying editorial. “Modern advanced neuroimaging might shed light on the role of damage to neural circuitry, neurotransmitter changes, and inflammation.” – by Amanda Oldt

Disclosure: The researchers reported no relevant financial disclosures.