Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis

BACKGROUND: Depression after stroke is a distressing problem that may be associated with other negative health outcomes. AIMS: To estimate the natural history, predictors and outcomes of depression after stroke. METHOD: Studies published up to 31 August 2011 were searched and reviewed according to accepted criteria. RESULTS: Out of 13 558 references initially found, 50 studies were included. Prevalence of depression was 29% (95% CI 25-32), and remains stable up to 10 years after stroke, with a cumulative incidence of 39-52% within 5 years of stroke. The rate of recovery from depression among patients depressed a few months after stroke ranged from 15 to 57% 1 year after stroke. Major predictors of depression are disability, depression pre-stroke, cognitive impairment, stroke severity and anxiety. Lower quality of life, mortality and disability are independent outcomes of depression after stroke. CONCLUSION: Interventions for depression and its potential outcomes are required.