umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Depression after stroke
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
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 [en]
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: urn:nbn:se:umu:diva-96912ISBN: 91-7174-768-0 (print)OAI: oai:DiVA.org:umu-96912DiVA: diva2:769198
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
List of papers
1. Life before and after Stroke: Living Conditions and Life Satisfaction in Relation to a General Elderly Population
Open this publication in new window or tab >>Life before and after Stroke: Living Conditions and Life Satisfaction in Relation to a General Elderly Population
1992 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 2, no 1, 28-34 p.Article in journal (Refereed) Published
Abstract [en]

Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.

Place, publisher, year, edition, pages
S. Karger, 1992
National Category
Sociology Psychiatry
Identifiers
urn:nbn:se:umu:diva-99080 (URN)10.1159/000108984 (DOI)
Projects
digitalisering@umu
Available from: 2015-02-04 Created: 2015-02-03 Last updated: 2017-12-05
2. Psychosocial function and life satisfaction after stroke
Open this publication in new window or tab >>Psychosocial function and life satisfaction after stroke
1992 (English)In: Stroke, Vol. 23, no 4, 527-531 p.Article in journal (Refereed) Published
Abstract [en]

This prospective study was designed to describe different aspects of psychosocial function after stroke and the development of changes over time. A major aim has been to identify mental, functional, and social factors associated with low life satisfaction late after stroke.

Social network, functional ability, leisure-time activities, experience of ill health, major depression, and life satisfaction were assessed repeatedly over 3 years in a population-based sample of 50 long-term survivors of stroke (mean age 71.4 years).

Compared with a general elderly population, patients 3 years poststroke had more psychiatric symptoms, lower functional ability, and reduced life satisfaction. Contacts with children were maintained over the 3-year follow-up period, whereas contacts with friends and neighbors declined early after stroke and remained lower than in the general elderly population (p less than 0.05). When time dependency was analyzed, activities of daily living and somatic/neurological symptoms were found to change little after 3 months, while psychiatric symptoms showed changes later. Between 3 and 12 months poststroke, the prevalence of major depression decreased, leisure-time activities and social contacts were partly resumed, and life satisfaction improved (p less than 0.01). Once good life satisfaction was restored it was maintained, and poor life satisfaction at 1 year remained poor for the entire 3 years.

It is concluded that major depression early after stroke, functional disability, and an impaired social network interact to reduce life satisfaction for the long-term survivors of stroke.

Place, publisher, year, edition, pages
American Heart Association, 1992
Keyword
Stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-99077 (URN)10.1161/01.STR.23.4.527 (DOI)
Projects
digitalisering@umu
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-04-10Bibliographically approved
3. Major depression in stroke patients: A 3-year longitudinal study
Open this publication in new window or tab >>Major depression in stroke patients: A 3-year longitudinal study
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
Keyword
activities of daily living, depression, social support
National Category
Psychiatry Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-36378 (URN)10.1161/01.STR.24.7.976 (DOI)8322398 (PubMedID)
Projects
digitalisering@umu
Available from: 2010-09-29 Created: 2010-09-29 Last updated: 2015-12-07
4. Hypercortisolism revealed by the dexamethasone suppression test in patients with acute ischemic stroke
Open this publication in new window or tab >>Hypercortisolism revealed by the dexamethasone suppression test in patients with acute ischemic stroke
1989 (English)In: Stroke, Vol. 20, no 12, 1685-1690 p.Article in journal (Refereed) Published
Abstract [en]

Using the dexamethasone suppression test, we studied the activity of the hypothalamicpituitary-adrenal axis within the first week after onset in 62 patients with acute ischemic stroke. Compared with two control groups (one comprising 25 elderly patients with various acute medical disorders and the other comprising 33 80-year-old volunteers), stroke patients had higher postdexamethasone cortisol levels (p=0.08 and /?=0.001, respectively). By multiple regression analysis, high postdexamethasone cortisol levels in the stroke patients were significantly associated with proximity of the lesion to the frontal pole of the brain (p=0.008) and with disorientation (p=0.03), whereas no association with major depression was seen. Many stroke patients are exposed to hypercortisolism, which may have negative consequences upon organ functions. The extent to which dexamethasone administration suppresses cortisol levels seems to be determined mainly by the site of brain lesion and cannot be used as an indicator of major depression early after stroke.

Place, publisher, year, edition, pages
American Heart Association, 1989
National Category
Psychiatry Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-99078 (URN)10.1161/01.STR.20.12.1685 (DOI)
Projects
digitalisering@umu
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-04-10Bibliographically approved
5. Different linkage of depression to hypercortisolism early versus late after stroke: A 3-year longitudinal study
Open this publication in new window or tab >>Different linkage of depression to hypercortisolism early versus late after stroke: A 3-year longitudinal study
1993 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, no 1, 52-57 p.Article in journal (Refereed) Published
Abstract [en]

 Using the dexamethasone suppression test, we studied the suppressibility of the cortisol axis and its clinical determinants at various time points after stroke. A major aim was to examine the dexamethasone test as a diagnostic tool for the diagnosis of major depression in stroke patients.The dexamethasone suppression test, major depression, functional ability, and disorientation were assessed in a cohort of 70 patients with acute stroke and after 3 months (n = 63) and 3 years (n = 43).Early after stroke, 24% of the patients were nonsuppressors, with about the same proportion at 3 months (22%) and 3 years (21%). None of the controls (17 healthy elderly volunteers) were nonsuppressors. High cortisol levels early after stroke were significantly associated with functional impairment (r = 0.35; p = 0.003) and disorientation (r = 0.27; p = 0.03). Three years after stroke, high postdexamethasone cortisol levels were significantly associated with major depression (r = 0.57; p < 0.001). The sensitivity of the dexamethasone test was 70% and the specificity 97%. In a longitudinal analysis of the long-term survivors (n = 42), postdexamethasone cortisol values at 3 months predicted major depression at 3 years.Hypercortisolism is associated with major depression late (3 years) but not early (0-3 months) after stroke. Patients with hypercortisolism 3 months after stroke are at risk of major depression later in the course and warrant careful follow-up from a psychiatric viewpoint.

Place, publisher, year, edition, pages
American Heart Association, 1993
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-99079 (URN)10.1161/01.STR.24.1.52 (DOI)
Projects
digitalisering@umu
Available from: 2015-02-04 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved

Open Access in DiVA

fulltext(11039 kB)146 downloads
File information
File name FULLTEXT01.pdfFile size 11039 kBChecksum SHA-512
fd563f9d77c99b96ae2b3e72c43a70f7231841cc2a2a51b7b850e2a54b3ca41ab475918a441a82e2b6943190bf123c300fa96bbfa9f77a6d3524d556076a9c2e
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Åström, Monica
By organisation
Psychiatry
Medical and Health SciencesPsychiatry

Search outside of DiVA

GoogleGoogle Scholar
Total: 146 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 185 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf