Terese S H Jørgensen1, Ida K Wium-Andersen2, Marie K Wium-Andersen3, Martin B Jørgensen4, Eva Prescott5, Solvej Maartensson6, Per Kragh-Andersen7, Merete Osler1. 1. Research Center for Prevention and Health, Rigshospitalet-Glostrup, Copenhagen University, Glostrup, Denmark2Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 2. Research Center for Prevention and Health, Rigshospitalet-Glostrup, Copenhagen University, Glostrup, Denmark3Psychiatric Center Ballerup, Ballerup, Denmark. 3. Research Center for Prevention and Health, Rigshospitalet-Glostrup, Copenhagen University, Glostrup, Denmark4Department of Psychiatry, Frederiksberg Hospital, Frederiksberg, Denmark. 4. Department of Psychiatry O, Rigshospitalet, Copenhagen, Denmark. 5. Department of Cardiology Y, Bispebjerg Hospital, Copenhagen, Denmark. 6. Research Center for Prevention and Health, Rigshospitalet-Glostrup, Copenhagen University, Glostrup, Denmark7Competence Center for Dual Diagnosis, Psychiatric Center Section Hans, Roskilde, Denmark. 7. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Abstract
IMPORTANCE: More than 30 million people live with a stroke diagnosis worldwide. Depression after stroke is frequent, and greater knowledge of associated risk factors and outcomes is needed to understand the etiology and implications of this disabling complication. OBJECTIVES: To examine whether the incidence of and risk factors for depression differ between patients with stroke and a reference population without stroke and to assess how depression influences mortality. DESIGN, SETTING, AND PARTICIPANTS: Register-based cohort study in Denmark. Participants were all individuals 15 years or older with a first-time hospitalization for stroke between January 1, 2001, and December 31, 2011 (n = 157 243), and a reference population (n = 160 236) matched on age, sex, and municipality. The data were analyzed between January and March 2016. MAIN OUTCOMES AND MEASURES: The incidence of depression and mortality outcomes of depression (defined by hospital discharge diagnoses or antidepressant medication use) were examined using Cox proportional hazards regression analyses. RESULTS: In total, 34 346 patients (25.4%) with stroke and 11 330 (7.8%) in the reference population experienced depression within 2 years after study entry. Compared with the reference population, patients with stroke had a higher incidence of depression during the first 3 months after hospitalization (hazard ratio for stroke vs the reference population, 8.99; 95% CI, 8.61-9.39), which declined during the second year of follow-up (hazard ratio for stroke vs the reference population, 1.93; 95% CI, 1.85-2.08). Significant risk factors for depression for patients with stroke and the reference population included older age, female sex, single cohabitation status, basic educational attainment, diabetes, high level of somatic comorbidity, history of depression, and stroke severity (in patients with stroke). The associations were strongest for the reference population. In both populations, depressed individuals, especially those with new onset, had increased all-cause mortality (hazard ratio for new-onset depression, 1.89 [95% CI, 1.83-1.95] for patients with stroke and 3.75 [95% CI, 3.51-4.00] for the reference population) after adjustment for confounders. Similar patterns were found for natural and unnatural causes of death. In most models, the depression-related relative mortality was approximately twice as high in the reference population vs the stroke population. CONCLUSIONS AND RELEVANCE: Depression is common in patients with stroke during the first year after diagnosis, and those with prior depression or severe stroke are especially at risk. Because a large number of deaths can be attributable to depression after stroke, clinicians should be aware of this risk.
IMPORTANCE: More than 30 million people live with a stroke diagnosis worldwide. Depression after stroke is frequent, and greater knowledge of associated risk factors and outcomes is needed to understand the etiology and implications of this disabling complication. OBJECTIVES: To examine whether the incidence of and risk factors for depression differ between patients with stroke and a reference population without stroke and to assess how depression influences mortality. DESIGN, SETTING, AND PARTICIPANTS: Register-based cohort study in Denmark. Participants were all individuals 15 years or older with a first-time hospitalization for stroke between January 1, 2001, and December 31, 2011 (n = 157 243), and a reference population (n = 160 236) matched on age, sex, and municipality. The data were analyzed between January and March 2016. MAIN OUTCOMES AND MEASURES: The incidence of depression and mortality outcomes of depression (defined by hospital discharge diagnoses or antidepressant medication use) were examined using Cox proportional hazards regression analyses. RESULTS: In total, 34 346 patients (25.4%) with stroke and 11 330 (7.8%) in the reference population experienced depression within 2 years after study entry. Compared with the reference population, patients with stroke had a higher incidence of depression during the first 3 months after hospitalization (hazard ratio for stroke vs the reference population, 8.99; 95% CI, 8.61-9.39), which declined during the second year of follow-up (hazard ratio for stroke vs the reference population, 1.93; 95% CI, 1.85-2.08). Significant risk factors for depression for patients with stroke and the reference population included older age, female sex, single cohabitation status, basic educational attainment, diabetes, high level of somatic comorbidity, history of depression, and stroke severity (in patients with stroke). The associations were strongest for the reference population. In both populations, depressed individuals, especially those with new onset, had increased all-cause mortality (hazard ratio for new-onset depression, 1.89 [95% CI, 1.83-1.95] for patients with stroke and 3.75 [95% CI, 3.51-4.00] for the reference population) after adjustment for confounders. Similar patterns were found for natural and unnatural causes of death. In most models, the depression-related relative mortality was approximately twice as high in the reference population vs the stroke population. CONCLUSIONS AND RELEVANCE: Depression is common in patients with stroke during the first year after diagnosis, and those with prior depression or severe stroke are especially at risk. Because a large number of deaths can be attributable to depression after stroke, clinicians should be aware of this risk.
Authors: Ida Kim Wium-Andersen; Marie Kim Wium-Andersen; Martin Balslev Jørgensen; Merete Osler Journal: J Psychiatry Neurosci Date: 2017-09 Impact factor: 6.186
Authors: Katherine L Musliner; Peter P Zandi; Xiaoqin Liu; Thomas M Laursen; Trine Munk-Olsen; Preben B Mortensen; William W Eaton Journal: Am J Geriatr Psychiatry Date: 2017-07-12 Impact factor: 4.105
Authors: Linghui Deng; Xuejun Sun; Shi Qiu; Yao Xiong; Yuxiao Li; Lu Wang; Qiang Wei; Deren Wang; Ming Liu Journal: Sci Rep Date: 2017-11-28 Impact factor: 4.379
Authors: Aurora Dollenberg; Sebastian Moeller; Caroline Lücke; Ruihao Wang; Alexandra P Lam; Alexandra Philipsen; Jürgen M Gschossmann; Falk Hoffmann; Helge H O Müller Journal: BMC Psychiatry Date: 2021-06-07 Impact factor: 3.630
Authors: Helge H O Müller; Jürgen M Gschossmann; Katharina Czwalinna; Ruihao Wang; Caroline Lücke; Alexandra P Lam; Alexandra Philipsen; Sebastian Moeller Journal: Psychiatr Q Date: 2021-01-02