Depressive disorder is a common and debilitating mental health condition that often occurs after a stroke. Known as poststroke depression (PSD), this condition has been linked to a range of adverse outcomes, including impaired functional ability, reduced quality of life, and increased mortality. Despite its significant impact, PSD is often underestimated and underdiagnosed.
Previous studies, including several large meta-analyses, have estimated the prevalence of depression after a stroke at around 30%. However, these studies have not always differentiated between self-reported depression scales and clinical interview diagnoses, which can impact the accuracy of estimates.
To address this issue, routine screening for PSD is recommended by several guidelines, although there is still debate about the optimal time to screen stroke survivors for depression. A study published in PLOS Medicine has identified different trajectories of depressive symptoms after stroke, ranging from no to persistent and recurrent symptoms. Understanding the natural history of depression after stroke can help inform clinical management and tailor rehabilitation programs to target those most in need.
Yet, to date, no meta-analysis has evaluated the pooled estimates of other measures of natural history, such as persistence and recovery, which could further improve our understanding of PSD. By recognizing the importance of PSD and developing more accurate methods of diagnosis and treatment, we can reduce the individual and socioeconomic burden of this condition on stroke survivors and their families.
This new study has found that the prevalence of post-stroke depression (PSD) is 27%, with rating scales indicating a slightly higher prevalence of 29% compared to 24% diagnosed by clinical interview. This is the first study to compare the prevalence of PSD using robust clinical interviews versus rating questionnaires. The study also evaluated the natural history of depression after stroke and found that two-thirds of episodes of depression within the first year after stroke started within the first three months.
Persistent depression was experienced by over half of these patients, while just under half had recovered. The onset of depression was less common after three months. The study recommends that clinical attention be paid to patients with depressive symptoms within three months post-stroke, especially those with worse functional impairments at baseline and those with pre-stroke depression. Further population-based studies are needed to investigate the prevalence and incidence of PSD at different time points and the persistent patterns with long-term follow-up.
Long-term depression is more prevalent in individuals who suffer depression shortly after their stroke (within the first three months), particularly those with more significant functional impairment at baseline and those who were depressed before their stroke. Improved monitoring and treatment may result in better outcomes. Stroke survivors who suffer from depression may benefit from tried-and-true treatments such as antidepressant medication and psychotherapy.
Depression that appears three months to a year following a stroke is less prevalent in the first year. Yet, the development of depression in older persons is poorly understood. PSD’s prevalence, incidence, and long-term trends should be investigated in large populations. Second, because of their incapacity to engage, persons with aphasia are often excluded from depression screening. It is still difficult to correctly estimate the incidence and prevalence of PSD.
Calculations of the ordinary course of depression after a stroke that can be applied to a diverse group of patients will necessitate representative studies that include patients with communicative or cognitive impairments. Lastly, depression appears to be less frequent in poorer and middle-income nations. It is critical to emphasize post-stroke mental health difficulties in low- and middle-income countries, which account for more than two-thirds of the global stroke burden.
