Key result
Long-term follow-up links stroke to an increase in post-stroke depression prevalence from 36% to 45%.
Why the study?
Long-term changes in post-stroke depression, emotional incontinence, and anger have rarely been studied.
Cohort (n=222)
Yes
In the long-term period after stroke, the prevalence of depression increases and is strongly associated with low social support, whereas emotional incontinence and anger tend to decrease.
PSD prevalence rose years post-stroke as PSEI/PSA fell; leaves open whether social support interventions mitigate late PSD.
BACKGROUND AND PURPOSE: Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. METHODS: This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim's criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. RESULTS: A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. CONCLUSIONS: The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.
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Kwon et al. (2021) conducted a cohort in Ischemic stroke (n=222). Long-term period post-stroke vs. 6 months post-stroke was evaluated on Prevalence of post-stroke depression (PSD) (p=0.03). At a median follow-up of 59.5 months, the prevalence of post-stroke depression significantly increased to 44.6% compared to 35.6% at 6 months, while emotional incontinence and anger decreased.
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