Poststroke Depression and Risk of Recurrent Stroke at 1 Year in a Chinese Cohort Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute stroke (n=2306). Intervention: Poststroke depression (PSD) vs. No poststroke depression. Primary outcome: Cumulative recurrent stroke at 1 year (OR 1.49, 95% CI 1.03-2.15).

Q: What does this research mean for the field?

Poststroke depression at 2 weeks following an acute stroke is associated with a 49% increased risk of recurrent stroke at 1 year compared to patients without poststroke depression. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Huai Wu Yuan; Chun Xue Wang; Ning Zhang; Ying Bai; Yuzhi Shi; Yong Zhou; Yi Wang; Tong Zhang; Juan Zhou; Xin Yu; Xin Yu Sun; Zhao rui Liu; Xing Zhao; Yong Jun Wang

doi:10.1371/journal.pone.0046906

October 17, 2012PLoS ONEOpen Access

Poststroke Depression and Risk of Recurrent Stroke at 1 Year in a Chinese Cohort Study

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Key result

Poststroke depression at 2 weeks following an acute stroke was associated with a 49% increased risk of recurrent stroke at 1 year compared to patients without poststroke depression (OR 1.49).

Why the study?

Does poststroke depression at 2 weeks increase the risk of recurrent stroke at 1 year in patients with acute stroke?

Study Design

Type

Cohort (n=2,306)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does poststroke depression at 2 weeks increase the risk of recurrent stroke at 1 year in patients with acute stroke?

P

Population

1,713 adults (≥18 years) with acute stroke (ischemic, intracerebral hemorrhage, or subarachnoid hemorrhage) within 14 days of onset, mean age ~61, 65.6% male, based in China. Excluded patients with severe communicative problems, prior depression or antidepressant use, illicit drug dependence, or loss to follow-up.

I

Intervention

Poststroke depression (PSD) diagnosed at 2 weeks following stroke onset using DSM-IV criteria (exposure).

C

Comparator

No poststroke depression at 2 weeks following stroke onset.

O

Outcome

Cumulative recurrent stroke rate at 1 year (defined as new neurological symptoms or stroke diagnosed at re-admission, confirmed by positive imaging results).hard clinical

Main Result

Effect estimate: OR 1.49 (95% CI 1.03-2.15)

Absolute Event Rate: 12% vs 8.1%

Poststroke depression at 2 weeks is an independent predictor of recurrent stroke at 1 year, highlighting the importance of psychological assessment and management in stroke survivors.

Limitations

Patients were extracted from urban hospitals above secondary level, limiting generalizability.
Patients with communicative problems precluding psychiatric examination were excluded, potentially underestimating PSD incidence.
Asymptomatic silent strokes established by imaging only were not included.
39.9% of patients had unclear recurrent stroke types and 29.7% had unclear dates of recurrent stroke.
Internal validity was limited due to the non-random observational study design.
25.8% of patients had incomplete follow-up information.
Patients extracted from urban hospitals above secondary level (mostly teaching hospitals), limiting generalizability to primary or rural hospitals.
Excluded patients with severe communicative problems, potentially underestimating PSD incidence and severity.
Asymptomatic silent strokes established by imaging only were not included, potentially underestimating actual recurrent stroke rate.
Non-random observational study design limits internal validity.

Implication

Supports poststroke depression screening; leaves open whether treatment reduces recurrent stroke risk.

Abstract

Background: Studies show that poststroke depression (PSD) increases mortality risk at 1 year. However, whether PSD increases the risk of recurrent stroke at 1 year remains unclear. This study was to investigate whether PSD at 2 weeks following a stroke could increase risk of recurrent stroke at 1 year.

Discussion

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Cite This Study

Yuan et al. (2012) conducted a cohort in Acute stroke (n=2,306). Poststroke depression (PSD) vs. No poststroke depression was evaluated on Cumulative recurrent stroke at 1 year (OR 1.49, 95% CI 1.03-2.15). Poststroke depression at 2 weeks following an acute stroke was associated with a 49% increased risk of recurrent stroke at 1 year compared to patients without poststroke depression (OR 1.49).

synapsesocial.com/papers/6a1c20b200ee29383e9d7f27 https://doi.org/10.1371/journal.pone.0046906

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Poststroke Depression and Risk of Recurrent Stroke at 1 Year in a Chinese Cohort Study

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Poststroke Depression and Risk of Recurrent Stroke at 1 Year in a Chinese Cohort Study

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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