DEPRESSION AFTER STROKE - RESULTS OF THE FINNSTROKE STUDY

Background and Purpose-We compared the incidence and severity of depre ssion at 3 and 12 months after stroke in patients and their chief care givers (spouses, 63%; children, 37%) in four districts of Finland, two with and two without after-hospital-discharge interventional programs (outpatient rehabilitation and activities of the local divisions of t he Finnish Heart Association [FHA]). A population-based stroke registe r was used, and factors influencing depression were analyzed. Methods- A stroke register of patients recruited over 2 years in four different districts (total population, 134804) in Finland; 594 first-ever strok es were registered. Beck's Depression Inventory (BDI), with 10 as the cutoff point for depression, was applied to 321 of 423 survivors and 1 95 caregivers at 3 months and to 311 of 390 survivors and 184 caregive rs at 12 months in the districts with and without interventional progr ams. Results-At 3 months, fewer patients in the districts with active programs (41%) were depressed than in the control districts (54%) (odd s ratio, 0.59; 95% confidence interval, 0.37 to 0.94), and the differe nce was maintained at 12 months (42% versus 55%) (odds ratio, 0.55; 95 % confidence interval, 0.34 to 0.88). Univariate risk factors for depr ession at 3 months were female sex and severe prognostic score at the onset of stroke (less than or equal to 14 points) on the Scandinavian Stroke Scale (SSS). Only SSS prognostic score and age emerged as signi ficant independent contributors re, depression on both linear and logi stic multivariate analyses. There was no significant difference in the depression rate of caregivers between districts with active programs (42%) and those without such programs (41%) at 3 months; at 12 months the results were the same (39% in districts with active programs versu s 42% in those without such programs). However, at 12 months there wer e significantly more severely depressed caregivers in districts withou t active programs than in districts with such programs (P.036). Poor R ankin scale score (grades III through V) and severe SSS long-term scor e (less than or equal to 42 points) at 3 months among the patients wer e associated with depression of the caregivers at 3 months in the univ ariate analysis. Poor Rankin Scale score of the patients was independe ntly associated with the depression of their caregivers at 3 months on multivariate logistic regression analysis. Conclusions-Depression was common among stroke survivors and among their caregivers at 3 months, and its rate did not decrease at 1-year follow-up. The lower depressi on rate in districts with active programs compared to those without su pports the idea that outpatient rehabilitation and support provided by local divisions of the FHA may be an effective way of decreasing the rate of depression after stroke.