S A Ayis1,2,3, A G Rudd1,4, L Ayerbe5, C D A Wolfe1,2,3. 1. School of Population Health and Environmental Sciences, King's College London, London. 2. National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London. 3. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South London at King's College Hospital NHS Foundation Trust, London. 4. Stroke Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London. 5. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Abstract
BACKGROUND AND PURPOSE: Depression is a common neuropsychiatric consequence of stroke. We identified trajectories of depression symptoms in men and women and examined their associations with 10-year all-cause mortality. METHODS: Data were obtained from the South London Stroke Register (1998-2016). Socio-demographic, stroke severity and clinical measures were collected during the acute phase. The Hospital Anxiety and Depression Scale was used to screen for depression at 3 months after stroke and then annually. We used group-based trajectory models to identify trajectories of depression and Cox proportional hazards models to study the risk of mortality in them. RESULTS: We studied 1275 men and 1038 women. Three trajectories of depression symptoms were identified in men: I-M (42.12%), low and stable symptoms; II-M (46.51%), moderate increasing symptoms; and III-M (11.37%), severe persistent symptoms. Four trajectories were identified in women; I-F (29.09%), low symptoms; II-F (49.81%), moderate symptoms; III-F (16.28%), severe symptoms; and IV-F (4.82%), very severe symptoms, all with stable symptoms. The 10-year adjusted mortality hazard ratios in men were: 1.68 [95% confidence interval (CI), 1.38-2.04] and 2.62 (95% CI, 1.97-3.48) for trajectories II-M and III-M, respectively, compared with I-M. In women these were: 1.38 (95% CI, 1.09-1.75), 1.65 (95% CI, 1.23-2.20) and 2.81 (95% CI, 1.90-4.16) for trajectories II-F, III-F and IV-F, respectively, compared with I-F. CONCLUSIONS: Depression trajectories varied independent of sex. Severe symptoms in women were double those in men. Moderate symptoms in men became worse over time. Increased symptoms of depression were associated with higher mortality rates. Data on symptom progression may help a better long-term management of patients with stroke.
BACKGROUND AND PURPOSE:Depression is a common neuropsychiatric consequence of stroke. We identified trajectories of depression symptoms in men and women and examined their associations with 10-year all-cause mortality. METHODS: Data were obtained from the South London Stroke Register (1998-2016). Socio-demographic, stroke severity and clinical measures were collected during the acute phase. The Hospital Anxiety and Depression Scale was used to screen for depression at 3 months after stroke and then annually. We used group-based trajectory models to identify trajectories of depression and Cox proportional hazards models to study the risk of mortality in them. RESULTS: We studied 1275 men and 1038 women. Three trajectories of depression symptoms were identified in men: I-M (42.12%), low and stable symptoms; II-M (46.51%), moderate increasing symptoms; and III-M (11.37%), severe persistent symptoms. Four trajectories were identified in women; I-F (29.09%), low symptoms; II-F (49.81%), moderate symptoms; III-F (16.28%), severe symptoms; and IV-F (4.82%), very severe symptoms, all with stable symptoms. The 10-year adjusted mortality hazard ratios in men were: 1.68 [95% confidence interval (CI), 1.38-2.04] and 2.62 (95% CI, 1.97-3.48) for trajectories II-M and III-M, respectively, compared with I-M. In women these were: 1.38 (95% CI, 1.09-1.75), 1.65 (95% CI, 1.23-2.20) and 2.81 (95% CI, 1.90-4.16) for trajectories II-F, III-F and IV-F, respectively, compared with I-F. CONCLUSIONS:Depression trajectories varied independent of sex. Severe symptoms in women were double those in men. Moderate symptoms in men became worse over time. Increased symptoms of depression were associated with higher mortality rates. Data on symptom progression may help a better long-term management of patients with stroke.
Authors: Adalia H Jun-O'Connell; Dilip K Jayaraman; Nils Henninger; Brian Silver; Majaz Moonis; Anthony J Rothschild Journal: Stroke Res Treat Date: 2020-09-22
Authors: Laura C Polding; William J Tate; Michael Mlynash; Michael P Marks; Jeremy J Heit; Soren Christensen; Stephanie Kemp; Gregory W Albers; Maarten G Lansberg Journal: Stroke Date: 2021-02-18 Impact factor: 7.914