From the Departments of Psychiatry (N.H.); Medicine (Neurology), Research
Program in Aging (S.E.B., J.L.); and Research Design and Biostatistics (C.S.,
J.P.S.), Sunnybrook Health Science Centre and University of Toronto, North
York, Ontario, Canada.
Correspondence to Nathan Herrmann, MD, Division of Geriatric Psychiatry, Sunnybrook Health Science Centre, 2075 Bayview Ave, Room FG20, North York, ON M4N 3M5, Canada. E-mail n.herrmann{at}utoronto.ca
Background and Purpose—To assess the
prevalence of depressive symptoms, their clinical correlates, and the
effects of depressive symptoms on stroke recovery, a relatively
unselected, well-diagnosed cohort of consecutive stroke survivors was
followed prospectively.
Methods—Consecutive admissions to a regional stroke center who
met World Health Organization and National Institute of Neurological
Disorders and Stroke criteria for stroke were eligible.
Subarachnoid hemorrhage and brain stem strokes were
excluded. Patients underwent CT, single-photon emission CT, and
standardized neurological and cognitive examinations at entry. At 3
months and 1 year after stroke, depressive symptoms were assessed with
the Montgomery Asberg Depression Rating Scale (MADRS) and the Zung
Self-Rating Depression Scale (SDS). Functional outcome was measured
with the Functional Independence Measure, and handicap was assessed by
the Oxford Handicap Scale.
Results—We assessed 436 patients at entry (mean±SD age,
74.9±11.6 years). There were 150 patients available for assessment at
3 months and 136 at 1 year. Marked depressive symptoms were noted in
22% (SDS) to 27% (MADRS) at 3 months and 21% (SDS) to 22% (MADRS)
at 1 year. Patents with marked depressive symptoms had more
neurological impairment (P<.008), were more likely to
be female (P<.05), and were more likely to have
previous histories of depression (P<.03). There was no
relationship between depressive symptoms and age, lesion volume, or
side of lesion. Depressive symptoms were correlated with functional
outcome (r=-.31, P<.0001) and handicap
(r=.41, P<.0001) at 3 months and 1 year
(r=-.28, P<.001; r=.35,
P<.0001).
Conclusions—Depressive symptoms and functional outcome are
correlated. In view of the prevalence of depressive symptoms in this
population, diagnosis and treatment of depression are important in
optimizing recovery.
© 1998 American Heart Association, Inc.
Original Contributions
The Sunnybrook Stroke Study
A Prospective Study of Depressive Symptoms and Functional Outcome
Key Words: depression • outcome
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