Background. Depression after stroke may have great burden on the likelihood of functional recovery and long-term outcomes. Objective. To estimate the association between depression after stroke and subsequent mortality. Methods. A systematic search of articles using PubMed and Web of Science databases was performed. Odds ratios (ORs) and hazard ratios (HRs) were used as association measures for pooled analyses, based on random-effects models. Results. Thirteen studies, involving 59,598 subjects suffering from stroke (6,052 with and 53,546 without depression), had data suitable for meta-analysis. The pooled OR for mortality at followup in people suffering from depression after stroke was 1.22 (1.02–1.47). Subgroups analyses highlighted that only studies with medium-term followup (2–5 years) showed a statistically significant association between depression and risk of death. Four studies had data suitable for further analysis of pooled HR. The meta-analysis revealed a HR for mortality of 1.52 (1.02–2.26) among people with depression after stroke. Conclusions. Despite some limitations, this paper confirms the potential role of depression on post stroke mortality. The relationship between depression and mortality after stroke seems to be related to the followup duration. Further research is needed to clarify the nature of the association between depression after stroke and mortality. 1. Introduction Stroke represents the third most common cause of death in developed countries, following only coronary heart diseases and cancer [1]. It is frequently associated with higher risk for a wide range of physical and neuropsychological consequences [2, 3]. Although the importance of poststroke psychiatric comorbidity is currently well documented, it had been previously underestimated [4]. In the 1970s, the identification of mood disorders, especially depression, as specific complications following stroke introduced the concept that clinical depression after stroke could be an organic consequence of the brain damage rather than an understandable psychological reaction to motor disability [5, 6]. Since then, research on depression after stroke has gained momentum [7]. However, despite the large bulk of the literature which has been published on this topic, there is still uncertainty in relation to depression after stroke prevalence, etiology, and management. Although the risk of all depressive disorders was reported ranging from 25% to 79% among people suffering from a stroke [21], poststroke major depression prevalence ranged from 3% to 40% [22]. Data available from
References
[1]
J. Mackay and G. A. Mensah, Deaths from Stroke. The Atlas of Heart Disease and Stroke, World Health Organization, Geneva, Switzerland, 2004, http://www.who.int/cardiovascular_diseases/en/cvd_atlas_16_death_from_stroke.pdf.
[2]
J. A. Bourgeois, D. M. Hilty, C. H. Chang, M. A. Wineinger, and M. E. Servis, “Poststroke neuropsychiatric illness: an integrated approach to diagnosis and management,” Current Treatment Options in Neurology, vol. 6, no. 5, pp. 403–420, 2004.
[3]
S. M. Lai, S. Studenski, P. W. Duncan, and S. Perera, “Persisting consequences of stroke measured by the stroke impact scale,” Stroke, vol. 33, no. 7, pp. 1840–1844, 2002.
[4]
A. J. Carson, “Impact commentaries. Mood disorder as a specific complication of stroke,” Journal of Neurology, Neurosurgery & Psychiatry, vol. 83, no. 9, p. 859, 2012.
[5]
M. F. Folstein, R. Maiberger, and P. R. McHugh, “Mood disorder as a specific complication of stroke,” Journal of Neurology Neurosurgery and Psychiatry, vol. 40, no. 10, pp. 1018–1020, 1977.
[6]
R. G. Robinson, W. J. Shoemaker, M. Schlumpf, T. Valk, and F. E. Bloom, “Effect of experimental cerebral infarction in rat brain on catecholamines and behaviour,” Nature, vol. 255, no. 5506, pp. 332–334, 1975.
[7]
R. G. Robinson, “Poststroke depression: prevalence, diagnosis, treatment, and disease progression,” Biological Psychiatry, vol. 54, no. 3, pp. 376–387, 2003.
[8]
O. P. Almeida and J. Xiao, “Mortality associated with incident mental health disorder after stroke,” Australian and New Zealand Journal of Psychiatry, vol. 41, no. 3, pp. 274–281, 2007.
[9]
C. Ellis, Y. Zhao, and L. E. Egede, “Depression and increased risk of death in adults with stroke,” Journal of Psychosomatic Research, vol. 68, no. 6, pp. 545–551, 2010.
[10]
A. House, P. Knapp, J. Bamford, and A. Vail, “Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month,” Stroke, vol. 32, no. 3, pp. 696–701, 2001.
[11]
H. Jia, T. M. Damush, H. Qin et al., “The impact of poststroke depression on healthcare use by veterans with acute stroke,” Stroke, vol. 37, no. 11, pp. 2796–2801, 2006.
[12]
R. E. Jorge, R. G. Robinson, S. Arndt, and S. Starkstein, “Mortality and poststroke depression: a placebo-controlled trial of antidepressants,” American Journal of Psychiatry, vol. 160, no. 10, pp. 1823–1829, 2003.
[13]
C. Kemper, D. Koller, G. Glaeske, and H. van den Bussche, “Mortality and nursing care dependency one year after first ischemic stroke: an analysis of German statutory health insurance data,” Topics in Stroke Rehabilitation, vol. 18, no. 2, pp. 172–178, 2011.
[14]
P. L. P. Morris, R. G. Robinson, P. Andrzejewski, J. Samuels, and T. R. Price, “Association of depression with 10-year poststroke mortality,” American Journal of Psychiatry, vol. 150, no. 1, pp. 124–129, 1993.
[15]
P. L. P. Morris, R. G. Robinson, and J. Samuels, “Depression, introversion and mortality following stroke,” Australian and New Zealand Journal of Psychiatry, vol. 27, no. 3, pp. 443–449, 1993.
[16]
H. Naess, L. Lunde, J. Brogger, and U. Waje-Andreassen, “Depression predicts unfavourable functional outcome and higher mortality in stroke patients: the Bergen Stroke Study,” Acta Neurologica Scandinavica, vol. 122, no. 190, pp. 34–38, 2010.
[17]
S. Paolucci, C. Gandolfo, L. Provinciali, R. Torta, V. Toso, and DESTRO Study Group, “The Italian multicenter observational study on post-stroke depression (DESTRO),” Journal of Neurology, vol. 253, no. 5, pp. 556–562, 2006.
[18]
L. D. Ried, H. Jia, H. Feng et al., “Selective serotonin reuptake inhibitor treatment and depression are associated with poststroke mortality,” Annals of Pharmacotherapy, vol. 45, no. 7-8, pp. 888–897, 2011.
[19]
J. Z. Willey, N. Disla, Y. P. Moon et al., “Early depressed mood after stroke predicts long-term disability: the Northern Manhattan Stroke Study (NOMASS),” Stroke, vol. 41, no. 9, pp. 1896–1900, 2010.
[20]
L. S. Williams, S. S. Ghose, and R. W. Swindle, “Depression and other mental health diagnoses increase mortality risk after ischemic stroke,” American Journal of Psychiatry, vol. 161, no. 6, pp. 1090–1095, 2004.
[21]
W. A. Gordon and M. R. Hibbard, “Poststroke depression: an examination of the literature,” Archives of Physical Medicine and Rehabilitation, vol. 78, no. 6, pp. 658–663, 1997.
[22]
K. A. Spencer, C. A. Tompkins, and R. Schulz, “Assessment of depression in patients with brain pathology: the case of stroke,” Psychological Bulletin, vol. 122, no. 2, pp. 132–152, 1997.
[23]
M. L. Hackett, C. Yapa, V. Parag, and C. S. Anderson, “Frequency of depression after stroke: a systematic review of observational studies,” Stroke, vol. 36, no. 6, pp. 1330–1340, 2005.
[24]
L. de Wit, K. Putman, I. Baert et al., “Anxiety and depression in the first six months after stroke. A longitudinal multicentre study,” Disability and Rehabilitation, vol. 30, no. 24, pp. 1858–1866, 2008.
[25]
A. Srivastava, A. B. Taly, A. Gupta, and T. Murali, “Post-stroke depression: prevalence and relationship with disability in chronic stroke survivors,” Annals of Indian Academy of Neurology, vol. 13, no. 2, pp. 123–127, 2010.
[26]
J. P. Fedoroff, S. E. Starkstein, R. M. Parikh, T. R. Price, and R. G. Robinson, “Are depressive symptoms nonspecific in patients with acute stroke?” American Journal of Psychiatry, vol. 148, no. 9, pp. 1172–1176, 1991.
[27]
D. S. P. Schubert, R. Burns, W. Paras, and E. Sioson, “Increase of medical hospital length of stay by depression in stroke and amputation patients: a pilot study,” Psychotherapy and Psychosomatics, vol. 57, no. 1-2, pp. 61–66, 1992.
[28]
K. Salter, S. K. Bhogal, N. Foley, J. Jutai, and R. Teasell, “The assessment of poststroke depression,” Topics in Stroke Rehabilitation, vol. 14, no. 3, pp. 1–24, 2007.
[29]
T. Pohjasvaara, R. Vataja, A. Lepp？vuori, M. Kaste, and T. Erkinjuntti, “Depression is an independent predictor of poor long-term functional outcome post-stroke,” European Journal of Neurology, vol. 8, no. 4, pp. 315–319, 2001.
[30]
R. Gillen, T. L. Eberhardt, H. Tennen, G. Affleck, and Y. Groszmann, “Screening for depression in stroke: relationship to rehabilitation efficiency,” Journal of Stroke and Cerebrovascular Diseases, vol. 8, no. 5, pp. 300–306, 1999.
[31]
E. Chemerinski, R. G. Robinson, and J. T. Kosier, “Improved recovery in activities of daily living associated with remission of poststroke depression,” Stroke, vol. 32, no. 1, pp. 113–117, 2001.
[32]
R. G. Robinson, K. Bolla-Wilson, E. Kaplan, J. R. Lipsey, and T. R. Price, “Depression influences intellectual impairment in stroke patients,” British Journal of Psychiatry, vol. 148, pp. 541–547, 1986.
[33]
S. Serrano, J. Domingo, E. Rodríguez-Garcia, M. D. Castro, and T. del Ser, “Frequency of cognitive impairment without dementia in patients with stroke: a two-year follow-up study,” Stroke, vol. 38, no. 1, pp. 105–110, 2007.
[34]
H. W. Yuan, C. X. Wang, N. Zhang et al., “Poststroke depression and risk of recurrent stroke at 1 year in a chinese cohort study,” PLoS One, vol. 7, article e46906, no. 10, 2012.
[35]
P. L. P. Morris, R. G. Robinson, and B. Raphael, “Prevalence and course of depressive disorders in hospitalized stroke patients,” International Journal of Psychiatry in Medicine, vol. 20, no. 4, pp. 349–364, 1990.
[36]
R. G. Robinson and G. Spalletta, “Poststroke depression: a review,” Canadian Journal of Psychiatry, vol. 55, no. 6, pp. 341–349, 2010.
[37]
D. F. Stroup, J. A. Berlin, S. C. Morton et al., “Meta-analysis of observational studies in epidemiology: a proposal for reporting,” Journal of the American Medical Association, vol. 283, no. 15, pp. 2008–2012, 2000.
[38]
Review Manager (RevMan), Version 5.1., The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark, 2011.
[39]
StataCorp, Stata Statistical Software: Release 10, StataCorp LP, College Station, Tex, USA, 2007.
[40]
S. Paolucci, “Epidemiology and treatment of post-stroke depression,” Neuropsychiatric Disease and Treatment, vol. 4, no. 1, pp. 145–154, 2008.
[41]
M. Egger, M. Schneider, and G. D. Smith, “Meta-analysis spurious precision? meta-analysis of observational studies,” British Medical Journal, vol. 316, no. 7125, pp. 140–144, 1998.
[42]
D. A. Grimes and K. F. Schulz, “Bias and causal associations in observational research,” The Lancet, vol. 359, no. 9302, pp. 248–252, 2002.
[43]
A. Dossa, M. E. Glickman, and D. Berlowitz, “Association between mental health conditions and rehospitalization, mortality, and functional outcomes in patients with stroke following inpatient rehabilitation,” BMC Health Services Research, vol. 11, p. 311, 2011.
[44]
G. Carrà, S. Johnson, P. Bebbington et al., “The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC),” European Archives of Psychiatry and Clinical Neuroscience, vol. 262, no. 7, pp. 607–616, 2012.
[45]
M. L. Hackett and C. S. Anderson, “Predictors of depression after stroke: a systematic review of observational studies,” Stroke, vol. 36, no. 10, pp. 2296–2301, 2005.
[46]
J. Blume, S. D. Douglas, and D. L. Evans, “Immune suppression and immune activation in depression,” Brain, Behavior, and Immunity, vol. 25, no. 2, pp. 221–229, 2011.
[47]
J. Barth, M. Schumacher, and C. Herrmann-Lingen, “Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis,” Psychosomatic Medicine, vol. 66, no. 6, pp. 802–813, 2004.
[48]
G. Carrà, P. Sciarini, G. Segagni-Lusignani, M. Clerici, C. Montomoli, and R. C. Kessler, “Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country,” European Psychiatry, vol. 26, no. 2, pp. 122–127, 2011.
[49]
K. Mikami, R. E. Jorge, H. P. Adams Jr. et al., “Effect of antidepressants on the course of disability following stroke,” American Journal of Geriatric Psychiatry, vol. 19, no. 12, pp. 1007–1015, 2011.
[50]
L. Wiart, H. Petit, P. A. Joseph, J. M. Mazaux, and M. Barat, “Fluoxetine in early poststroke depression: a double-blind placebo-controlled study,” Stroke, vol. 31, no. 8, pp. 1829–1832, 2000.
[51]
G. Andersen, K. Vestergaard, and L. Lauritzen, “Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram,” Stroke, vol. 25, no. 6, pp. 1099–1104, 1994.
[52]
L. Rampello, S. Chiechio, G. Nicoletti et al., “Prediction of the response to citalopram and reboxetine in post-stroke depressed patients,” Psychopharmacology, vol. 173, no. 1-2, pp. 73–78, 2004.
[53]
L. Rampello, A. Alvano, S. Chiechio, R. Raffaele, I. Vecchio, and M. Malaguarnera, “An evaluation of efficacy and safety of reboxetine in elderly patients affected by "retarded" post-stroke depression: a random, placebo-controlled study,” Archives of Gerontology and Geriatrics, vol. 40, no. 3, pp. 275–285, 2005.
[54]
M. L. Hackett, C. S. Anderson, A. House, and J. Xia, “Interventions for treating depression after stroke,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD003437, 2008.
[55]
M. L. Hackett, C. S. Anderson, A. House, and C. Halteh, “Interventions for preventing depression after stroke,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD003689, 2008.
[56]
G. Carrá, G. S. Lusignani, P. Sciarini, F. Barale, A. Marinoni, and M. Clerici, “And how shall we deal with adaptation and implementation of NICE schizophrenia guidelines in Italy?” Epidemiologia e Psichiatria Sociale, vol. 17, no. 4, pp. 258–262, 2008.
