Background: Post-stroke depression is very prevalent among stroke survivors but is often missed or underdiagnosed. There is much attention given to the physical rehabilitation of stroke survivors, with little or no attention given to the psychological sequelae of stroke. Aim: To investigate the occurrence of post-stroke depression among stroke survivors at the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Materials and Methods: This cross-sectional study was conducted among stroke survivors at the University of Calabar Teaching Hospital. All the stroke survivors had a CT scan-confirmed stroke. A consecutive sampling method was used to recruit respondents. The following questionnaires were administered to 122 stroke survivors. Sociodemographic/clinical questionnaire, National Institute of Health Stroke Scale (NIHSS), The Mini-International Neuropsychiatry Interview (MINI)-Depression module, Mini-Mental State Examination (MMSE), Oslo Social Support Scale (OSSS-3), and the Modified Rankin Scale (MRS). The data were analysed using SPSS version 25. Results: The study recruited 122 stroke survivors. The prevalence of Post-Stroke Depression among the respondents was 36.9%. The mean age of the participants was 60.23 ± 13.0. The proportion of male respondents was 62.3%, while that of female respondents was 37.7%. Respondents with right hemispheric stroke were 51.6%, while those with left hemispheric stroke were 36.1%. The proportion of respondents with ischaemic stroke (87.1%) was higher than that of those with hemorrhagic stroke (12.3%). The predictors of post-stroke depression in the study include respondents with comorbid diabetes mellitus (OR = 6.9, 95% CI = 1.4 - 32.9, p = 0.01) and those with coexisting hypertension and diabetes (OR = 24.1, 95% CI = 1.0 - 572, p = 0.04). Conclusion: The result of the study showed that depression among stroke survivors is high among the study population. This condition is often neglected by the primary physicians managing these patients, leading to poor treatment outcomes. Efforts should be made to include psychological assessment/treatment in the routine care of stroke patients.
References
[1]
Abiola, T., Udofia, O., & Zakari, M. (2013). Psychometric Properties of the 3-Item Oslo Social Support Scale among Clinical Students of Bayero University Kano, Nigeria. Malaysian Journal of Psychiatry, 22, 32-41.
[2]
Abubakar, S., Iwuozuo, E., Magaji, M., Obiakor, R., & Sabir, A. (2014). Depression in Long-Term Stroke Survivors. Sub-SaharanAfricanJournalofMedicine,1, 119-123. https://doi.org/10.4103/2384-5147.138935
[3]
Adebusoye, L. A., Arinola, G., Amaefula, G., Hunter, S., Merl, H., & Pitt, V. (2021). Comparison of the Rowland University Dementia Assessment Scale and Mini-Mental State Examination Cognitive Screening Tools among Older People in Nigeria. MedicalJournalofZambia,48, 388-396. https://doi.org/10.55320/mjz.48.4.915
[4]
Akinyemi, R. O., Ovbiagele, B., Adeniji, O. A., Sarfo, F. S., Abd-Allah, F., Adoukonou, T. et al. (2021). Stroke in Africa: Profile, Progress, Prospects and Priorities. NatureReviewsNeurology,17, 634-656. https://doi.org/10.1038/s41582-021-00542-4
[5]
Andersen, G., Vestergaard, K., Riis, J. Ø., & Ingeman‐Nielsen, M. (1996). Dementia of Depression or Depression of Dementia in Stroke? ActaPsychiatricaScandinavica,94, 272-278. https://doi.org/10.1111/j.1600-0447.1996.tb09860.x
[6]
Ayerbe, L., Ayis, S., Wolfe, C. D. A., & Rudd, A. G. (2013). Natural History, Predictors and Outcomes of Depression after Stroke: Systematic Review and Meta-Analysis. British Journal ofPsychiatry,202, 14-21. https://doi.org/10.1192/bjp.bp.111.107664
[7]
Ayres, J. L. (2015). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. In F. J. Domino, et al. (Eds.), The 5-Minute Clinical Consult Standard 2016: Twenty Fourth Edition.
[8]
Baiyewu, O., Akinbiyi, A., Ogunniyi, A., Gureje, O., Smith-Gamble, V., Lane, K. A. et al. (2003). Behavioral and Caregiver Reaction of Dementia as Measured by the Neuropsychiatrie Inventory in Nigerian Community Residents. InternationalPsychogeriatrics,15, 399-409. https://doi.org/10.1017/s1041610203009645
[9]
Bakare AT,, Amin HH,, Adebisi A,, Abubakar A,, Yakubu AI,, Yakubu AI, et al. (2024). Assessment of Depressive Symptoms among Post Stroke Patients Attending a Nigerian Tertiary Hospital. IbomMedicalJournal,17, 334-339. https://doi.org/10.61386/imj.v7i2.446
[10]
Bi, H., & Wang, M. (2022). Role of Social Support in Poststroke Depression: A Meta-Analysis. FrontiersinPsychiatry,13, Article 924277. https://doi.org/10.3389/fpsyt.2022.924277
[11]
Black, D. W., Arndt, S., Hale, N., & Rogerson, R. (2004). Use of the Mini International Neuropsychiatric Interview (MINI) as a Screening Tool in Prisons: Results of a Preliminary Study. JournaloftheAmericanAcademyofPsychiatryandtheLawOnline,32, 158-162.
[12]
Brott, T., Adams, H. P., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J. et al. (1989). Measurements of Acute Cerebral Infarction: A Clinical Examination Scale. Stroke,20, 864-870. https://doi.org/10.1161/01.str.20.7.864
[13]
Chaturvedi, P., Tiwari, V., Singh, A., Qavi, A., & Thacker, A. (2020). Depression Impedes Neuroplasticity and Quality of Life after Stroke. JournalofFamilyMedicineandPrimaryCare,9, 4039. https://doi.org/10.4103/jfmpc.jfmpc_273_20
[14]
Chemerinski, E., & Robinson, R. G. (2000). The Neuropsychiatry of Stroke. Psychosomatics,41, 5-14. https://doi.org/10.1016/s0033-3182(00)71168-6
[15]
Cullen, B., O'Neill, B., Evans, J. J., Coen, R. F., & Lawlor, B. A. (2007). A Review of Screening Tests for Cognitive Impairment. JournalofNeurology,Neurosurgery&Psychiatry,78, 790-799. https://doi.org/10.1136/jnnp.2006.095414
[16]
Dawodu, C. O., & Olaniyan, K. A. (2012). The Predictive Value of the National Institute of Health Stroke Scale (NIHSS) For Haemmorhagic Stroke Patients in a Non-Interventional Study. OnlineJournalofMedicineandMedicalScienceResearch,1, 42-48.
[17]
de Haan, R., Limburg, M., Bossuyt, P., van der Meulen, J., & Aaronson, N. (1995). The Clinical Meaning of Rankin ‘Handicap’ Grades after Stroke. Stroke,26, 2027-2030. https://doi.org/10.1161/01.str.26.11.2027
[18]
Ekeh, B., Ogunniyi, A., Isamade, E., & Ekrikpo, U. (2018). Stroke Mortality and Its Predictors in a Nigerian Teaching Hospital. AfricanHealthSciences,15, 74-80. https://doi.org/10.4314/ahs.v15i1.10
[19]
Eko Jimmy, E., Kalu, O., & Osuchukwu Nelson, C. (2013). Prevalence of Contraceptive Use among Women of Reproductive Age in Calabar Metropolis, Southern Nigeria. InternationalJournalofHumanitiesandSocialScienceInvention(IJHSSI),2, 27-34.
[20]
Eze, C. O., Afolabi, O. F., Nwigbakpo, C., & Ndulue, C. U. (2022). Post Stroke Depression: Experience at Abakaliki Nigeria. WorldJournalofNeuroscience,12, 38-44. https://doi.org/10.4236/wjns.2022.122005
[21]
Fan, T., & Rossi, C. (2015). Screening for Cognitive Impairment in Older Adults. AmericanFamilyPhysician,92, 125-126.
[22]
Fatoye, F. O., Komolafe, M. A., Eegunranti, B. A., Adewuya, A. O., Mosaku, S. K., & Fatoye, G. K. (2007). Cognitive Impairment and Quality of Life among Stroke Survivors in Nigeria. PsychologicalReports,100, 876-882. https://doi.org/10.2466/pr0.100.3.876-882
[23]
Feigin, V. L., Brainin, M., Norrving, B., Martins, S., Sacco, R. L., Hacke, W. et al. (2022). World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. InternationalJournalofStroke,17, 18-29. https://doi.org/10.1177/17474930211065917
[24]
Folstein, M. F., Maiberger, R., & McHugh, P. R. (1977). Mood Disorder as a Specific Complication of Stroke.. JournalofNeurology,Neurosurgery&Psychiatry,40, 1018-1020. https://doi.org/10.1136/jnnp.40.10.1018
[25]
Galea, M., & Woodward, M. (2005). Mini-Mental State Examination (MMSE). AustralianJournalofPhysiotherapy,51, 198. https://doi.org/10.1016/s0004-9514(05)70034-9
[26]
Gyagenda, J. O., Ddumba, E., Odokonyero, R., Kaddumukasa, M., Sajatovic, M., Smyth, K. et al. (2015). Post-Stroke Depression among Stroke Survivors Attending Two Hospitals in Kampala Uganda. AfricanHealthSciences,15, 1220-1232. https://doi.org/10.4314/ahs.v15i4.22
[27]
Hackett, M. L., & Anderson, C. S. (2005). Predictors of Depression after Stroke: A Systematic Review of Observational Studies. Stroke,36, 2296-2301. https://doi.org/10.1161/01.str.0000183622.75135.a4
[28]
Hackett, M. L., Yapa, C., Parag, V., & Anderson, C. S. (2005). Frequency of Depression after Stroke: A Systematic Review of Observational Studies. Stroke,36, 1330-1340. https://doi.org/10.1161/01.str.0000165928.19135.35
[29]
House, A., Dennis, M., Warlow, C., Hawton, K., & Molyneux, A. (1990). The Relationship between Intellectual Impairment and Mood Disorder in the First Year after Stroke. PsychologicalMedicine,20, 805-814. https://doi.org/10.1017/s0033291700036497
[30]
Huang, Y., Singh, A., Chen, S., Sun, F., Huang, C., & Liu, S. (2019). Validity of a Novel Touch Screen Tablet-Based Assessment for Mild Cognitive Impairment and Probable AD in Older Adults. Assessment,26, 1540-1553. https://doi.org/10.1177/1073191117748395
[31]
Jones, L. R., Badger, L. W., Ficken, R. P., Leeper, J. D., & Anderson, R. L. (1987). Inside the Hidden Mental Health Network: Examining Mental Health Care Delivery of Primary Care Physicians. GeneralHospitalPsychiatry,9, 287-293. https://doi.org/10.1016/0163-8343(87)90085-5
[32]
Khedr, E. M., Abdelrahman, A. A., Desoky, T., Zaki, A. F., & Gamea, A. (2020). Post-Stroke Depression: Frequency, Risk Factors, and Impact on Quality of Life among 103 Stroke Patients—Hospital-Based Study. TheEgyptianJournalofNeurology,PsychiatryandNeurosurgery,56, Article No. 66. https://doi.org/10.1186/s41983-020-00199-8
[33]
Kocalevent, R., Berg, L., Beutel, M. E., Hinz, A., Zenger, M., Härter, M. et al. (2018). Social Support in the General Population: Standardization of the Oslo Social Support Scale (OSSS-3). BMCPsychology,6, Article No. 31. https://doi.org/10.1186/s40359-018-0249-9
[34]
Meltzer, H. (2003). Development of a Common Instrument for Mental Health. In A. Nosikiv, & C. Gudex (Eds.), EUROHIS:DevelopingCommonInstrumentsforHealthSurveys. IOS Press.
[35]
Mkpanam, N. E. (2012). Comparison of Knowledge, Attitude and Utilization of the National Health Insurance by Workers in the Teaching and General Hospitals in Calabar. Public Health.
[36]
Mordal, J., Gundersen, Ø., & Bramness, J. G. (2010). Norwegian Version of the Mini-International Neuropsychiatric Interview: Feasibility, Acceptability and Test-Retest Reliability in an Acute Psychiatric Ward. EuropeanPsychiatry,25, 172-177. https://doi.org/10.1016/j.eurpsy.2009.02.004
[37]
Morris, P. G., Wilson, J. T. L., & Dunn, L. (2004). Anxiety and Depression after Spontaneous Subarachnoid Hemorrhage. Neurosurgery,54, 47-54. https://doi.org/10.1227/01.neu.0000097198.94828.e1
[38]
Nemani, K., & Gurin, L. (2021). Neuropsychiatric Complications after Stroke. SeminarsinNeurology,41, 085-100. https://doi.org/10.1055/s-0040-1722723
[39]
Ele, I. E., & Nkang, M. O. (2014). Structure and Efficiency of Crayfish Marketing in Major Markets in Calabar, Cross River State, Nigeria.Journal of Business and Management, 16, 26-32. https://doi.org/10.9790/487X-16442632
[40]
Nys, G. M. S., van Zandvoort, M. J. E., van der Worp, H. B., de Haan, E. H. F., de Kort, P. L. M., & Kappelle, L. J. (2005). Early Depressive Symptoms after Stroke: Neuropsychological Correlates and Lesion Characteristics. Journal of the Neurological Sciences, 228, 27-33. https://doi.org/10.1016/j.jns.2004.09.031
[41]
Ojagbemi, A., Akinyemi, R., & Baiyewu, O. (2014). Cognitive Dysfunction and Functional Limitations Are Associated with Major Depression in Stroke Survivors Attending Rehabilitation in Nigeria. NeuroRehabilitation:AnInternational,InterdisciplinaryJournal,34, 455-461. https://doi.org/10.3233/nre-141061
[42]
Ojagbemi, A., Akpa, O., Elugbadebo, F., Owolabi, M., & Ovbiagele, B. (2017). Depression after Stroke in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. BehaviouralNeurology,2017, Article ID: 4160259. https://doi.org/10.1155/2017/4160259
[43]
Oladiji, J., Akinbo, S., Aina, O., & Aiyejusunle, C. (2009). Risk Factors of Post-Stroke Depression among Stroke Survivors in Lagos, Nigeria. AfricanJournalofPsychiatry,12, 47-51. https://doi.org/10.4314/ajpsy.v12i1.30278
[44]
Olibamoyo, O., Adewuya, A., Ola, B., Coker, O., & Atilola, O. (2019). Prevalence and Correlates of Depression among Nigerian Stroke Survivors. SouthAfricanJournalofPsychiatry,25, Article 1252. https://doi.org/10.4102/sajpsychiatry.v25i0.1252
[45]
Oni, O. D., Olagunju, A. T., Olisah, V. O., Aina, O. F., & Ojini, F. I. (2018). Post-Stroke Depression: Prevalence, Associated Factors and Impact on Quality of Life among Outpatients in a Nigerian Hospital. SouthAfricanJournalofPsychiatry,24, Article 1058. https://doi.org/10.4102/sajpsychiatry.v24i0.1058
[46]
Opakunle, T., Aloba, O., Nwozo, C., Adesanya, D., & Adebimpe, O. (2023). Psychometric Adaptation of the Hospital Anxiety and Depression Scale as a Self-Rated Suicide Risk Assessment Instrument among Nigerian Surgical Patients. InternationalJournalofMedicineandHealthDevelopment,28, 330-336. https://doi.org/10.4103/ijmh.ijmh_34_23
[47]
Owolabi, M. O., & Ogunniyi, A. (2009). Profile of Health-Related Quality of Life in Nigerian Stroke Survivors. EuropeanJournalofNeurology,16, 54-62. https://doi.org/10.1111/j.1468-1331.2008.02339.x
[48]
Pinninti, N. R., Madison, H., Musser, E., & Rissmiller, D. (2003). MINI International Neuropsychiatric Schedule: Clinical Utility and Patient Acceptance. EuropeanPsychiatry,18, 361-364. https://doi.org/10.1016/j.eurpsy.2003.03.004
[49]
Pohjasvaara, T., Leppävuori, A., Siira, I., Vataja, R., Kaste, M., & Erkinjuntti, T. (1998). Frequency and Clinical Determinants of Poststroke Depression. Stroke,29, 2311-2317. https://doi.org/10.1161/01.str.29.11.2311
[50]
Popoola, A. O., & Adewuya, A. O. (2012). Prevalence and Correlates of Depressive Disorders in Outpatients with Breast Cancer in Lagos, Nigeria. Psycho-Oncology,21, 675-679. https://doi.org/10.1002/pon.1968
[51]
Robinson, R. G. (1997). Neuropsychiatric Consequences of Stroke. AnnualReviewofMedicine,48, 217-229. https://doi.org/10.1146/annurev.med.48.1.217
[52]
Robinson, R. G. (2006). TheClinicalNeuropsychiatryofStroke: Cognitive, Behavioral and Emotional Disorders Following Vascular Brain Injury. Cambridge University Press. https://doi.org/10.1017/cbo9780511544231
[53]
Robinson, R. G., & Jorge, R. E. (2016). Post-stroke Depression: A Review. AmericanJournalofPsychiatry,173, 221-231. https://doi.org/10.1176/appi.ajp.2015.15030363
[54]
Salihu, M. O., A. Abiodun, O., Omoniyi Ajiboye, P., Wasiu Wahab, K., & Bamiso Makanjuola, A. (2023). Post-stroke Depression and Serum High Sensitivity C-Reactive Protein among the Acute Stroke Population of a Teaching Hospital in Ilorin, Nigeria. AmericanJournalofMedicalSciencesandMedicine,11, 55-63. https://doi.org/10.12691/ajmsm-11-2-3
[55]
Schöttke, H., & Giabbiconi, C. (2015). Post-stroke Depression and Post-Stroke Anxiety: Prevalence and Predictors. InternationalPsychogeriatrics,27, 1805-1812. https://doi.org/10.1017/s1041610215000988
[56]
Schubert, D. S. P., Taylor, C., Lee, S., Mentari, A., & Tamaklo, W. (1992). Detection of Depression in the Stroke Patient. Psychosomatics, 33, 290-294. https://doi.org/10.1016/s0033-3182(92)71967-7
[57]
Shi, Y., Xiang, Y., Yang, Y., Zhang, N., Wang, S., Ungvari, G. S. et al. (2015). Depression after Minor Stroke: Prevalence and Predictors. JournalofPsychosomaticResearch,79, 143-147. https://doi.org/10.1016/j.jpsychores.2015.03.012
[58]
Shi, Y., Zeng, Y., Wu, L., Liu, W., Liu, Z., Zhang, S. et al. (2017). A Study of the Brain Abnormalities of Post-Stroke Depression in Frontal Lobe Lesion. ScientificReports,7, Article No. 13203. https://doi.org/10.1038/s41598-017-13681-w
[59]
Tatemichi, T. K., Desmond, D. W., Stern, Y., Paik, M., Sano, M., & Bagiella, E. (1994). Cognitive Impairment after Stroke: Frequency, Patterns, and Relationship to Functional Abilities. JournalofNeurology,Neurosurgery&Psychiatry,57, 202-207. https://doi.org/10.1136/jnnp.57.2.202
[60]
Tennen, G., Herrmann, N., Black, S. E., Levy, K. S., Cappell, J., Li, A. et al. (2011). Are Vascular Risk Factors Associated with Post-Stroke Depressive Symptoms? JournalofGeriatricPsychiatryandNeurology,24, 215-221. https://doi.org/10.1177/0891988711422526
[61]
Terroni, L., Sobreiro, M. F. M., Conforto, A. B., Adda, C. C., Guajardo, V. D., Lucia, M. C. S. D. et al. (2012). Association among Depression, Cognitive Impairment and Executive Dysfunction after Stroke. Dementia&Neuropsychologia,6, 152-157. https://doi.org/10.1590/s1980-57642012dn06030007
[62]
Theofanidis, D. (2014). From Apoplexy to Brain Attack, a Historical Perspective on Stroke to Date. JournalofNursing&Care,4, e121. https://doi.org/10.4172/2167-1168.1000e121
[63]
Van Lente, E., Barry, M. M., Molcho, M., Morgan, K., Watson, D., Harrington, J. et al. (2012). Measuring Population Mental Health and Social Well-Being. InternationalJournalofPublicHealth,57, 421-430. https://doi.org/10.1007/s00038-011-0317-x
[64]
Vataja, R., Pohjasvaara, T., Leppävuori, A., Mäntylä, R., Aronen, H. J., Salonen, O. et al. (2001). Magnetic Resonance Imaging Correlates of Depression after Ischemic Stroke. ArchivesofGeneralPsychiatry,58, 925-931. https://doi.org/10.1001/archpsyc.58.10.925
[65]
Wahab, K. W. (2008). The Burden of Stroke in Nigeria. InternationalJournalofStroke,3, 290-292. https://doi.org/10.1111/j.1747-4949.2008.00217.x
[66]
Whyte, E. M., Mulsant, B. H., Vanderbilt, J., Dodge, H. H., & Ganguli, M. (2004). Depression after Stroke: A Prospective Epidemiological Study. JournaloftheAmericanGeriatricsSociety,52, 774-778. https://doi.org/10.1111/j.1532-5415.2004.52217.x
[67]
Wilson, J. T. L., Hareendran, A., Hendry, A., Potter, J., Bone, I., & Muir, K. W. (2005). Reliability of the Modified Rankin Scale across Multiple Raters: Benefits of a Structured Interview. Stroke,36, 777-781. https://doi.org/10.1161/01.str.0000157596.13234.95
[68]
World Health Organization (2018). InternationalClassificationofDiseasesfor Mortality and Morbidit Statistics EleventhRevision.Icd-11.
[69]
Zhang, Y., He, J., Liang, H., Lu, W., Yang, G., Liu, J. et al. (2017). Diabetes Mellitus Is Associated with Late-Onset Post-Stroke Depression. JournalofAffectiveDisorders,221, 222-226. https://doi.org/10.1016/j.jad.2017.06.045
