Trajectories and Influencing Factors of Depression in Patients with H-Type Hypertension-Related Ischemic Stroke: A Single-Center Longitudinal Study

Background: This study aimed to identify depression trajectory patterns in patients with H-type hypertension-related ischemic stroke and explore predictors using the COM-B framework. Methods: A prospective longitudinal study enrolled 588 patients from a Chinese tertiary hospital (September 2023–December 2024). Data were collected at six time points (admission and 1, 3, 6, 9, 12 months post-discharge). Growth mixture modeling identified trajectory classes, and multivariate logistic regression determined predictive factors. Results: Four depression trajectory classes were identified: (1) Rapid Recovery group (n=155, 26.4%): swift symptom resolution; (2) Moderate Improvement group (n=70, 11.9%): moderate symptom improvement; (3) Persistent Low-Symptom group (n=102, 17.3%): optimal reference category; (4) Symptom-Aggravation group (n=261, 44.4%): exacerbation over time. Protective factors included positive health behaviors (strongest across all comparisons), first-time stroke onset, urban residence, and employed status (all p < 0.05). Risk factors included higher health knowledge levels, elevated homocysteine, unemployed/retired status, and higher social support. Notably, elevated homocysteine and higher social support were associated with worsening depression, especially in the Symptom-Aggravation group (p < 0.05). Conclusion: Four distinct depression trajectories were identified in H-type hypertension-related ischemic stroke patients, with specific predictors. These findings inform targeted interventions to improve depression outcomes.