Abstract 19: Resolving Post-Stroke Depression is associated with Post-Stroke Functional Recovery
Background/rationale: Depression is common after stroke and is associated with poor functional outcome, but its relationship with the change in functional status after adjustment for other factors remains uncertain. We investigated the independent relationship between depression and post-stroke functional recovery.
Methods: Data were obtained as part of the multicenter Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) registry in which depression assessed by a self-reported depressive symptoms scale (the Patient Health Questionnaire-8; PHQ-8≥10), and modified Rankin scale (mRS) were prospectively assessed 3 and 12 months following hospitalization for ischemic stroke. Univariate logistic analysis followed by multivariable logistic modeling adjusted for race, gender, age and post-hospital rehabilitation, was performed to evaluate the association between depression at each time-point and the change in mRS between 3 and 12 months.
Results: Data was available for 1444 patients (55.7% men, 82.6% White) from 97 hospitals in the United States. Relative to 3 months, the 12 month mRS was stable or improved in 692 (75.8%) and worse in 349 (24.2%) patients. Overall, 134 patients were persistently depressed, 126 had resolving depression by 12 months and 104 patients had incident depression at 12 months. Older age, lack of rehabilitation, and 3 and 12 months depression status were associated with worse disability (increasing mRS) between 3 and 12 months. After covariate adjustment, both depression status at 3 and 12 months (p= 0.010) and older age (OR= 1.02, 95% CI 1.01-1.03 per 10-years, p<0.001) remained associated with worsening mRS. Compared with those who were not depressed at either time point, those who had resolving depression (PHQ-8≥10 at 3 but not 12 months) were less likely to have a worsening mRS (OR=0.49, 95%CI 0.29-0.83) whereas the association between incident depression at 12 month and worsening mRS was marginal (OR=1.48, 95% CI 0.95-2.30). Being depressed at both time points was not associated with a worsening in mRS between 3 and 12 months (OR=0.85, 95% CI 0.53-1.34).
Conclusion: The change in depressive status between 3 and 12 months following hospitalization for stroke was associated with incremental changes in functional outcome. Patients who had resolving post-stroke depression were less likely to have worsening disability. A reciprocal relationship and a confounding effect between depression and mRS cannot be excluded.
- © 2012 by American Heart Association, Inc.