A cross-sectional study of prevalence and determinants of depression among stroke patients

Authors

  • Jim Litton Resident, Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Puducherry, India
  • Lokesh S. Associate Professor, Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Puducherry, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20162213

Keywords:

Cerebro vascular accident, PSD, Diabetes mellitus, Ischaemic heart disease, Hypertension, EMS

Abstract

Background: The association between depression and stroke is well known. Few studies show that lesion side and site are associated with post-stroke depression (PSD), but there exists a vast discrepancy in the results among various studies. The prevalence of post stroke depression also varies widely. In India there is paucity in the amount of literature in this context. Early detection of depression is of prime importance for better outcomes. The study was mainly intended to find out these variations.

Methods: To study the prevalence of post stroke depression, the neuroanatomical correlation of post stroke depression and impact of comorbid conditions in post stroke depression. This cross sectional study was designed at medicine department of MGMCRI, Puducherry, India. All adult patients with stroke (>40 years) presenting to the emergency medical services (EMS) and department of medicine were enrolled. Patients fulfilling the inclusion criteria were taken up for the study after obtaining consent. Data about pre-existing comorbid illness such as diabetes, hypertension, ischaemic heart disease and substance abuse like smoking, alcohol use were collected. Complete physical examination and CNS examination were performed. The findings of CT brain were documented including the site of lesion. Depression was assessed on the 14th day after stroke using PHQ-9 questionnaire. Chi square and regression analysis were employed for statistical analysis.

Results: The mean age of subjects in this study was found to be 63.84±11.40 years.  The prevalence of severe depression in this study was 47%. Milder form of depression was found in 53% of the subjects. Of the total population studied, statistically significant severe depression was associated with patients who had lesion on left hemisphere.

Conclusions: Post stroke depression is more associated primarily with left sided hemispheric lesions. The prevalence of significant post stroke depression in present study was 47%. This study highlights the importance of screening stroke patients for depression. Early intervention of post stroke depression can lead to better outcomes.

References

Burvill PW, Johnson GA, Jamrozik KD, Anderson CS, Stewart WEG, Chakera TM. Prevalence of depression after stroke: the perth community stroke study. Br J Psychiatry. 1995;166(3):320-7.

Appelros P, Viitanen M. Prevalence and predictors of depression at one year in a Swedish population-based cohort with first-ever stroke. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2004;13(2):52-7.

Vataja R, Leppavuori A, Pohjasvaara T, Mantyla R, Aronen HJ, Salonen O, et al. Poststroke depression and lesion location revisited. J Neuropsychiatry Clin Neurosci. 2004;16(2):156-62.

Rajamannar R, Robert GR, Alastair JF, Todd K, Thomas RP. Functional impairment associated with acute poststroke depression-the stroke data bank study. J Neuropsych Clinical Neurosci. 1998;10(1):26-33.

Townend BS, Whyte S, Desborough T. Longitudinal prevalence and determinants of early mood disorder post stroke. J Clin Neurosci. 2007;14:429-34.

Lara C, Jose MF, Catarina OS, Luisa MF. Depression in stroke. J Psychiatry Neurosci. 2006;31(6):377-83.

Berg A, Lonnqvist J, Palomaki H, Kaste M. Assessment of depression after stroke: a comparison of different screening instruments. Stroke J Cereb Circ. 2009;40(2):523-9.

Williams LS, Brizendine EJ, Plue L, Bakas T, Tu W, Hendrie H, et al. Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke J Cereb Circ. 2005;36(3):635-8.

Herrmann M, Bartels C, Schumacher M, Wallesch CW. Poststroke depression is there a pathoanatomic correlate for depression in the postacute stage of stroke? Stroke. 1995;26(5):850-6.

Thomas SA, Lincoln NB. Factors relating to depression after stroke. Br J Clin Psychol. 2006;45(1):49-61.

Desmond DW, Remien RH, Moroney JT, Stern Y, Sano M, Williams JBW. Ischemic stroke and depression. J Int Neuropsychol Soc. 2003;9(3):429-39.

Rajashekaran P, Pai K, Thunga R, Unnikrishnan B. Post-stroke depression and lesion location: a hospital based cross-sectional study. Indian J Psychiatry. 2013;55(4):343-8.

Narushima K, Kosier JT, Robinson RG. A reappraisal of poststroke depression, intra- and inter-hemispheric lesion location using meta-analysis. J Neuropsychiatry Clin Neurosci. 2003;15(4):422-30.

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Published

2016-12-29

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Section

Original Research Articles