FREQUENCY AND CLINICAL DETERMINANTS OF POSTSTROKE DEPRESSION

Background and Purpose-Previous studies have shown a large variation c oncerning the frequency of poststroke depression. This variation is ca used by differences in patient populations, psychiatric assessment met hods, and diagnostic criteria. In this study, we evaluated the frequen cy and clinical correlates of poststroke depression in a large well-de fined stroke cohort. Methods-We studied a consecutive series of 486 pa tients with ischemic stroke aged from 55 to 85 years. Of these, 277 pa tients underwent a comprehensive psychiatric evaluation, including the Present State Examination, from 3 to 4 months after ischemic stroke. The criteria of the Diagnostic and Statistical Manual of Mental Disord ers, edition 3, revised (DSM-III-R), were used for the diagnosis of de pressive disorders. Results-The frequency of any depressive disorder w as 40.1% (n=111). Major depression was diagnosed in 26.0% (n=72) and m inor depression in 14.1% (n=39). Major depression with no other explan atory factor besides stroke was diagnosed in 18.0% (n=49) of the patie nts. Comparing depressed and nondepressed patients, we found no statis tically significant difference in sex, age, education, stroke type, st roke localization, stroke syndrome, history of previous cerebrovascula r disease, or frequency of DSM-III-R dementia. According to the multip le logistic regression model, dependency in daily life correlated with the diagnosis of depression (odds ratio [OR], 1.8; 95% confidence int erval [CI], 1.1 to 3.1) and with the diagnosis of major depression (OR , 2.9; 95% CI, 1.6 to 5.5). A history of previous depressive episodes also correlated with the diagnosis of depression (OR, 2.3; 95% CI, 1.3 to 4.4) and with the diagnosis of major depression (OR, 2.9; 95% CI, 1.6 to 5.5), whereas solely stroke-related major depression correlated only weakly with stroke severity as measured on the Scandinavian Stro ke Scale (OR, 1.1; 95% CI, 1.0 to 1.1). Conclusions-Clinically signifi cant depression is frequent after ischemic stroke. We emphasize the im portance of the psychiatric examination of poststroke patients, especi ally those with a significant disability and with a history of prior d epressive episodes.