Cassidy Eugene, O'Connor Rory, O'Keane Veronica
Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Eire.
Disabil Rehabil. 2004 Jan 21;26(2):71-7. doi: 10.1080/09638280410001650142.
(1). To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2). To investigate factors predictive of depression following stroke. (3). To examine the relationship between post-stroke depression and outcome following inpatient rehabilitation.
Fifty consecutive patients meeting inclusion criteria who were admitted for inpatient rehabilitation to a specialised unit following their first stroke were prospectively studied.
first stroke 3 - 12 months previously, lesion identified on CT or MRI, age 18 - 65 years, at least some sensory/motor impairment, no pre-existing disabling condition and Barthel Index score > 14 prior to stroke. Mood (Center for Epidemiologic Studies Depression scale, Hamilton Depression Rating Scale, DSM-IV diagnostic criteria for Major Depressive Disorder), Cognition (Mini-Mental State Examination) and Disability (Barthel Index, Rankin Disability Scale) were assessed one week after admission (baseline) and again after 2 months of rehabilitation. Outcome was measured as effectiveness of rehabilitation (Shah et al., 1990) and length of inpatient stay (LOS).
10/50 (20%) of the sample met criteria for major depressive disorder on admission. The best predictor of depression was gender, with females having a two-fold higher rate of both subjectively reported and objectively rated depressive symptoms. Depression was unrelated to baseline Barthel Disability, side of lesion or previous psychiatric history. The best predictor of effectiveness of rehabilitation was baseline Barthel Disability score. Depression did not predict either effectiveness or LOS.
(1). Major depression is common in subjects undergoing rehabilitation following their first stroke. (2). Females appear to be especially at risk, possibly reflecting an increased general risk of depression. (3). Depression in our sample was not related to functional disability following stroke or early functional outcome following rehabilitation.
（1）. 调查首次中风后接受住院康复治疗的爱尔兰受试者样本中抑郁症状的患病率以及操作性定义的抑郁症（重度抑郁症）。（2）. 研究中风后抑郁症的预测因素。（3）. 研究中风后抑郁症与住院康复治疗结果之间的关系。
对连续50例符合纳入标准的患者进行前瞻性研究，这些患者在首次中风后被收治到一个专门的单位进行住院康复治疗。
中风发生在3至12个月前，CT或MRI检查发现病变，年龄在18至65岁之间，至少有一些感觉/运动障碍，无既往致残性疾病，中风前Barthel指数评分>14。入院一周后（基线）以及康复治疗2个月后再次评估情绪（流行病学研究中心抑郁量表、汉密尔顿抑郁评定量表、重度抑郁症的DSM-IV诊断标准）、认知（简易精神状态检查表）和残疾情况（Barthel指数、Rankin残疾量表）。康复效果（Shah等人，1990）和住院时间（LOS）作为结果进行测量。
样本中有10/50（20%）的患者入院时符合重度抑郁症标准。抑郁症的最佳预测因素是性别，女性主观报告和客观评定的抑郁症状发生率高出两倍。抑郁症与基线Barthel残疾程度、病变部位或既往精神病史无关。康复效果的最佳预测因素是基线Barthel残疾评分。抑郁症不能预测康复效果或住院时间。
（1）. 首次中风后接受康复治疗的受试者中重度抑郁症很常见。（2）. 女性似乎尤其有风险，这可能反映出抑郁症总体风险增加。（3）. 我们样本中的抑郁症与中风后的功能残疾或康复后的早期功能结果无关。
