Roberta Ferreira de Mello1, Itamar de Souza Santos2, Airlane Pereira Alencar3, Isabela Martins Benseñor2, Paulo Andrade Lotufo2, Alessandra Carvalho Goulart4. 1. Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil. Electronic address: robertamello@hu.usp.br. 2. Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil. 3. Institute of Mathematics and Statistics, University of São Paulo, São Paulo, São Paulo, Brazil. 4. Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: The influence of poststroke depression on long-term survival is poorly investigated. Thus, we aimed to evaluate the influence of major depression disorder (MDD) on long-term survival in the participants from The Study of Stroke Mortality and Morbidity in Adults (EMMA Study) in São Paulo, Brazil. METHODS: We prospectively evaluated ischemic and hemorrhagic stroke (HS) cases from the EMMA Study. Baseline and stroke characteristics and cardiovascular risk factors were evaluated according to MDD assessed by the Patient Health Questionnaire, which was applied 30 days after index event and periodically during 1-year follow-up. We performed Kaplan-Meier survival analysis, as well as crude and multiple Cox proportional hazards models. RESULTS: In this subset of the EMMA Study, we evaluated 164 (85.9%) patients with ischemic stroke and 27 (14.1%) with HS. Among these, overall incidence of MDD was 25.1% during 1 year of follow-up, regardless stroke subtype. The peak rate of major depression postacute event was beyond 1 month. We observed a lower survival rate among individuals who developed poststroke MDD than among those who did not develop this condition after 1 year of follow-up (85.4% versus 96.5%, log rank P = .006). After multiple analysis, we kept a higher risk of all-cause mortality among those who developed MDD compared to participants without MDD (hazard ratio = 4.60, 95% confidence interval = 1.36-15.55, P = .01). CONCLUSION: Our findings suggest that incident MDD is a potential marker of poor prognosis 1 year after stroke.
BACKGROUND: The influence of poststroke depression on long-term survival is poorly investigated. Thus, we aimed to evaluate the influence of major depression disorder (MDD) on long-term survival in the participants from The Study of Stroke Mortality and Morbidity in Adults (EMMA Study) in São Paulo, Brazil. METHODS: We prospectively evaluated ischemic and hemorrhagic stroke (HS) cases from the EMMA Study. Baseline and stroke characteristics and cardiovascular risk factors were evaluated according to MDD assessed by the Patient Health Questionnaire, which was applied 30 days after index event and periodically during 1-year follow-up. We performed Kaplan-Meier survival analysis, as well as crude and multiple Cox proportional hazards models. RESULTS: In this subset of the EMMA Study, we evaluated 164 (85.9%) patients with ischemic stroke and 27 (14.1%) with HS. Among these, overall incidence of MDD was 25.1% during 1 year of follow-up, regardless stroke subtype. The peak rate of major depression postacute event was beyond 1 month. We observed a lower survival rate among individuals who developed poststroke MDD than among those who did not develop this condition after 1 year of follow-up (85.4% versus 96.5%, log rank P = .006). After multiple analysis, we kept a higher risk of all-cause mortality among those who developed MDD compared to participants without MDD (hazard ratio = 4.60, 95% confidence interval = 1.36-15.55, P = .01). CONCLUSION: Our findings suggest that incident MDD is a potential marker of poor prognosis 1 year after stroke.
Authors: Francesco Bartoli; Carmen Di Brita; Cristina Crocamo; Massimo Clerici; Giuseppe Carrà Journal: Front Psychiatry Date: 2018-11-01 Impact factor: 4.157
Authors: Vinicius S P Pedroso; Andre R Brunoni; Érica L M Vieira; Ricardo E Jorge; Edward C Lauterbach; Antonio L Teixeira Journal: Clinics (Sao Paulo) Date: 2018-05-03 Impact factor: 2.365