Depression is an independent predictor of poor long-term functional outcome post-stroke

The influence of depression on the long-term outcome of stroke patients was examined among 390 of 486 consecutive patients aged 55-85 years. They comp leted, at 3 months after ischaemic stroke, a detailed medical, neurological , and radiological stroke evaluation, structured measures of emotion (Beck' s Depression Inventory, BDI), handicap (Rankin scale, RS), and assessment o f activities of daily living (Barthel Index. BI). Further RS and BI was eva luated at 15-month Follow-up from these 390 patients and BDI in 276 patient s. A group of 256 patients completed, in addition to the Ii-month follow-up , a comprehensive psychiatric evaluation, including the Present State Exami nation 3 months after stroke. The DSM-III-R criteria were used for diagnosi s of the depressive disorders. BDI identified depression (cut-off point gre ater than or equal to 10 for depression) in 171 (43.9%) of 390 and in 123 ( 44.6%) of 276 patients at 3- and 15-month follow-up. DSM-III-R major depres sion was diagnosed in 66 (25.8%), and minor depression in 32 (12.5%), of 25 6 patients 3 months after stroke. Patients with BDI greater than or equal t o 10, or major, but not minor, depression more often had poor functional ou tcome(RS > II and BI < 17) at 15 months. Poor functional outcome at 3 month s also correlated with depression at 15 months. In logistic regression anal ysis, depression at 3 months (Beck <greater than or equal to> 10) correlate d with poor functional outcome at 15 months (RS > II) (OR 2.5, 95% CI 1.6-3 .8). More careful examination and treatment of depression in stroke patient s is emphasized.