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Severe depression after stroke more common in women than men

Study findings revealed women were twice as likely as men to have severe depression after experiencing a stroke.

In their study, Salma Ayis, PhD, from King's College London School of Population Health & Environmental Sciences and the NHS Foundation Trust, and colleagues examined trajectories of depression symptoms in men and women of the South London Stroke Register using group-based trajectory models. They also examined how these trajectories were tied to 10-year all-cause mortality.

“Methods that assume that individuals belong to a single population overlook patient heterogeneity and are unable to detect varying patterns of change in variables over time,” Ayis and colleagues wrote in the European Journal of Neurology. “Group-based trajectory models (GBTMs) allow the identification of clusters of individuals that follow a similar developmental trajectory on predictors and outcomes and their long-term consequences.”

Participants were included if they had their first-ever stroke between 1998 and 2016. The researchers used the Hospital Anxiety and Depression Scale to screen for depression 3 months after stroke then annually.

Overall, the analysis included 1,275 men and 1,038 women. The results showed the trajectory of depressive symptoms following stroke differed by sex. The investigators identified three trajectories of depression symptoms in men: low and stable symptoms (I-M, 42.12%); moderate increasing symptoms (II-M, 46.51%); and severe persistent symptoms (III-M, 11.37%). In women, they identified four trajectories: low symptoms (I-F, 29.09%); moderate symptoms (II-F, 49.81%); severe symptoms (III-F, 16.28%); and very severe symptoms (IV-F, 4.82%).

The results showed that 20% of women had long-term severe or very severe depressive symptoms (III-F and IV-F) while 10% of men had long-term severe symptoms (III-M). Although moderate symptoms became worse over time in men, they remained the same in women. However, the risk for 10-year all-cause mortality increased as depressive symptoms increased for both sexes.

"While we cannot pinpoint exactly why depression is more common among women, it could be that women draw more of their sense of self and self-worth from their social relationships and so are more sensitive to challenges in maintaining these,” Ayis said in a press release. “Also, as women live longer, they are more exposed to loneliness, poor physical health and loss of support, all of which could lead to depression.”

Analysis revealed that the 10-year adjusted mortality HRs in men were 1.68 (95% CI, 1.38–2.04) and 2.62 (95% CI, 1.97–3.48) for trajectories II-M and III-M, respectively, compared with I-M, and in women were 1.38 (95% CI, 1.09–1.75), 1.65 (95% CI, 1.23–2.20) and 2.81 (95% CI, 1.90–4.16) for trajectories II-F, III-F and IV-F, respectively, compared with I-F.

"What is common to both sexes is the dramatic decrease in the likelihood of survival as depression symptoms increase,” Ayis said in the release. “We believe therefore, that by monitoring symptoms of depression in stroke survivors and acting accordingly, clinicians may be able to provide better long-term care.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.