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Major depression in stroke patients: A 3-year longitudinal study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.ORCID iD: 0000-0002-8114-7615
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
1993 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, no 7, 976-982 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.

Place, publisher, year, edition, pages
American Heart Association , 1993. Vol. 24, no 7, 976-982 p.
Keyword [en]
activities of daily living, depression, social support
National Category
Psychiatry Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-36378DOI: 10.1161/01.STR.24.7.976PubMedID: 8322398OAI: oai:DiVA.org:umu-36378DiVA: diva2:354009
Projects
digitalisering@umu
Available from: 2010-09-29 Created: 2010-09-29 Last updated: 2015-12-07
In thesis
1. Depression after stroke
Open this publication in new window or tab >>Depression after stroke
1993 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population.

Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke.

The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation.

Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 1993. 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 364
Keyword
Cerebrovascular disorders, stroke, depression, living conditions, life satisfaction, social network, dysphasia, self-care ability, cerebral atrophy, dexamethasone
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:umu:diva-96912 (URN)91-7174-768-0 (ISBN)
Public defence
1993-04-23, Aulan, Administrationsbyggnaden, BV, Norrlands Universitetssjukhus, Umeå universitet, Umeå, 10:00
Supervisors
Projects
digitalisering@umu
Note

Härtill 5 uppsatser

Available from: 2015-02-03 Created: 2014-12-05 Last updated: 2015-04-10Bibliographically approved

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Adolfsson, RolfAsplund, Kjell

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