General and disease-specific risk factors for depression after ischemic stroke: a two-step Cox regression analysis.

BACKGROUND: Post-stroke depression (PSD) frequently complicates stroke and is associated with an impaired functional outcome, more severe cognitive deficits, a reduced quality of life, and a higher mortality. The aim of this study was to assess whether general risk factors for major depressive disorder (MDD) in the community are also risk factors for PSD, and to identify additional, stroke-related risk factors. METHODS: In a hospital setting, 190 consecutively admitted patients were assessed for MDD 1 month after stroke, and at follow-up after 3, 6, 9 and 12 months. A Cox model was created with four established risk factors for MDD in the community (female sex, prior personal history of depression, positive family history of depression, and somatic comorbidity other than stroke). Five potential disease-related risk factors (disability, cognitive deterioration, inter- and intrahemispheric lesion location, and generalized vascular damage on computed tomography (CT) scan) were then added individually to this model, to see whether these would improve the significance of the overall model. RESULTS: The Cox model of four general risk factors for depression in the community was shown to be a valid model to predict depression in stroke patients. Of the disease-specific factors, only incorporation of "disability" in this model improved its significance. CONCLUSION: Established risk factors for depression in the community are also predictors of depression in the first year after stroke. Disability is a non-specific disease-related variable that is associated with PSD. The contribution of stroke-specific factors may be less than is generally assumed.

Personality and vulnerability to depression in stroke patients: a 1-year prospective follow-up study.

BACKGROUND AND PURPOSE: Depression is a frequent sequela of stroke that negatively interferes with rehabilitation outcome. Personality traits have been neglected as potential vulnerability factors for poststroke depression (PSD). In a 1-year prospective study, the influence of the 5 main personality traits (ie, neuroticism, extraversion, openness, agreeableness, and conscientiousness) on the development of PSD was studied. METHODS: One month after stroke, 190 consecutive patients with a first-ever supratentorial infarct were asked to complete a personality inventory, the NEO-Five Factor Inventory, which is based on the Five Factor Model of personality. Depressive symptoms were assessed 1, 3, 6, 9, and 12 months after stroke with 3 self-rating questionnaires as screening instruments for depression. PSD was diagnosed as major or minor depression through the use of the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders. RESULTS: The 1-year cumulative incidence of depression was 38.7%. Cox regression analysis showed that patients with high neuroticism scores had a 4.6-times-higher risk of developing PSD than patients with low neuroticism scores (P=0.001) regardless of lesion location. Level of handicap was the only other factor that showed an independent effect on the occurrence of PSD. CONCLUSIONS: Neuroticism is an important predictor of PSD, a finding that emphasizes the need to take personality into account as a potential vulnerability factor for depression in stroke patients. Research on PSD should aim at delineating the interplay between neurological and psychological factors in the development of PSD.

Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients.

Most instruments used to assess poststroke depression have never been specifically validated in stroke patients. This study evaluated the depression screening abilities of three questionnaires and one observer-rated scale in 202 consecutive patients 1 month after they experienced their first-ever ischemic stroke. At their respective optimum cutoff values, the sensitivity of the self-rated scales varied between 80% and 90%, while the specificity was about 60%. For the observer-rated scale (Hamilton Depression Rating Scale), sensitivity was 78.1%, and specificity was 74.6%. The instruments clearly performed better in men than in women. Despite this difference, it was concluded that all scales were acceptable screening instruments for poststroke depression.