Psychosocial risk factors in poststroke depression: A systematic review

Objective: To review systematically the psychosocial risk factors for posts troke depression. Methods: Medline was searched using the key words "poststroke depression" ( PSD) for the period January 1, 1966, to June 30, 2000; using the key words "cerebrovascular disease" and "depression" it was searched from June 1, 199 6, to June 30, 2000. Corollary articles were obtained from the bibliographi es. Inclusion criteria were as follows: original research in French or Engl ish; prospective, case-control or cross-sectional study design; assessment of PSD in the first 6 months following the stroke; an acceptable definition of depression; an acceptable definition of stroke; and at least one psycho social risk factor. Interrater reliability was tested for the selection and quality of the articles. A qualitative risk factor analysis was conducted Results: The risk-factors most consistently associated with PSD are a past history of depression, past personal psychiatric history, dysphasia, functi onal impairments, living alone, and poststroke social isolation. Risk facto rs not associated with PSD are dementia and cognitive impairment. Controver sial risk factors are age, socioeconomic status (SES), prior social distres s, dependency in regard to activities of daily living (ADL), and sex. Conclusions: Over approximately 30 years, some 25 qualitative studies have addressed psychosocial risk factors for PSD. Further studies should aim for quantitative analysis. The results suggest that identifying psychiatric hi story and preventing social deterioration and impairment should be part of multidisciplinary efforts to care for poststroke patients.