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From the Department of Clinical Neurosciences, Helsinki (Finland)
University Central Hospital (M.Ko., O.W., M.Ka.), and the Department of
Neurology, Central Hospital of South Karelia (H.N.).
Correspondence to Dr Mervi Kotila, Department of Clinical Neurosciences, Helsinki University Central Hospital, Haartmanninkatu 4, 00290 Helsinki, Finland.
Background and Purpose—We compared
the incidence and severity of depression at 3 and 12 months after
stroke in patients and their chief caregivers (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 the Finnish
Heart Association [FHA]). A population-based stroke register was
used, and factors influencing depression were analyzed.
Methods—A stroke register of patients recruited over 2 years in
four different districts (total population, 134 804) in Finland; 594
first-ever strokes were registered. Beck's Depression Inventory (BDI),
with 10 as the cutoff point for depression, was applied to 321 of 423
survivors and 195 caregivers at 3 months and to 311 of 390 survivors
and 184 caregivers at 12 months in the districts with and without
interventional programs.
Results—At 3 months, fewer patients in the districts with active
programs (41%) were depressed than in the control districts (54%)
(odds ratio, 0.59; 95% confidence interval, 0.37 to 0.94), and the
difference was maintained at 12 months (42% versus 55%) (odds ratio,
0.55; 95% confidence interval, 0.34 to 0.88). Univariate
risk factors for depression at 3 months were female sex and severe
prognostic score at the onset of stroke (
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 depression rate in districts with active
programs compared to those without supports 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.
© 1998 American Heart Association, Inc.
Original Contributions
Depression After Stroke
Results of the FINNSTROKE Study
14 points) on the
Scandinavian Stroke Scale (SSS). Only SSS prognostic score and age
emerged as significant independent contributors to depression on both
linear and logistic 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 versus 42% in those
without such programs). However, at 12 months there were significantly
more severely depressed caregivers in districts without active programs
than in districts with such programs (P.036). Poor
Rankin scale score (grades III through V) and severe SSS long-term
score (42 points) at 3 months among the patients were associated with
depression of the caregivers at 3 months in the univariate
analysis. Poor Rankin Scale score of the patients was
independently associated with the depression of their caregivers at 3
months on multivariate logistic regression
analysis.
Key Words: caregivers • depression • incidence • rehabilitation • stroke
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