What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Early post-stroke depression (n=119075). Intervention: Early post-stroke depression vs. No early post-stroke depression. Primary outcome: Mortality (RR 1.50, 95% CI 1.28 to 1.75, p=<0.001).

November 1, 2018Open Access

Early Post-stroke Depression and Mortality: Meta-Analysis and Meta-Regression

Q: What are the key findings of this study?

Early post-stroke depression was associated with a significantly higher risk of mortality compared to non-depressed individuals (RR 1.50).

Resultado clave

Early post-stroke depression was associated with a significantly higher risk of mortality compared to non-depressed individuals (RR 1.50).

Diseño del estudio

Tipo

Meta-Analysis (n=119,075)

PICO estructurado

Does early post-stroke depression increase mortality in stroke survivors?

Población

119,075 adults with acute stroke, including 17,609 with early post-stroke depression assessed within 3 months, followed for 1 to 10 years to evaluate mortality risk.

Exposición

Early post-stroke depression (PSD) occurring within the first 3 months after the acute stroke

Comparador

Non-depressed stroke survivors

Resultado

Mortalityhard clinical

Early post-stroke depression occurring within the first 3 months after an acute stroke is associated with a 1.5-fold increased risk of mortality.

Resultado numérico

Relative Risk: 1.5 (95% CI 1.28–1.75)

valor p: p=<0.001

Limitaciones

Inability to systematically control for treatment-related factors such as antidepressant medication
Lack of a gold standard for post-stroke depression diagnosis and variability in assessment tools across studies
Small number of included studies (seven) prevented assessment of publication bias

Resumen

Background Post stroke depression (PSD) is a common and serious complication after stroke. In this systematic review and meta-analysis, we evaluated the association between early PSD and mortality, considering depressive symptoms occurring within the first three months after the neurological event. Methods This meta-analysis was conducted following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and based on studies indexed till May 2018 in PubMed and Web of Science databases. The relative risk (RR) for mortality in individuals with PSD, as compared with non-depressed ones, was estimated. Findings were pooled according to a random-effects model. Meta-regression and subgroup analyses were carried out. Results We included seven studies, accounting for 119,075 individuals, of whom 17,609 suffering from an early PSD. We found higher rates of mortality in subjects with PSD as compared with non-depressed ones (RR = 1.50; 95%CI: 1.28 to 1.75; p<0.001). Heterogeneity across studies was moderate (I2=50.7%). Subgroup analysis showed a slightly higher effect of PSD on short-term mortality (RR=1.70; p<0.001), as compared with long-term one (RR=1.35; p=0.01). According to relevant meta-regression analyses, the estimate was influenced by sample proportion of men (p=0.043). Conclusions Despite some limitations, our study shows the negative impact of early PSD on mortality rates among stroke survivors. Mechanisms underlying this association still need to be elucidated and several interpretations can be hypothesized. Future research should test if an early management of depression may increase life expectancy after stroke.

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