Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Neurology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.
Int J Geriatr Psychiatry. 2014 Feb;29(2):144-52. doi: 10.1002/gps.3974. Epub 2013 Apr 29.
With a prevalence that varies between 20% and 65%, poststroke depression (PSD) is a frequent sequel of stroke. The aim of this study was to determine incidence and risk factors for PSD 18 months after stroke.
As part of the Middelheim Interdisciplinary Stroke Study, patients were followed up for 18 months in this prospective and longitudinal epidemiological study. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale. Activities, including social activities, were measured with the Stroke Impact Scale (SIS). Relational problems since stroke onset were defined by a questionnaire.
Data analysis was performed on 125 patients who completed follow-up assessments. Depression (CSD score ≥8) was diagnosed in 28% of the patients. Patients with PSD were more dependent for activities of daily living and displayed more physical and cognitive impairment than patients without PSD. The risk to become depressed decreased with 5% when the patient's activities increased with one unit on the SIS (odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.93-0.97). Patients with persistent relational problems since stroke onset had approximately four and a half times greater risk of becoming depressed than patients without (OR = 4.48; 95%CI = 1.17-16.87).
Multiple regression models indicated that the most determining features for developing PSD at 18 months poststroke include reduced activity and relationship problems due to stroke. Further studies on risk factors for PSD are essential, including psychosocial aspects, given its negative impact on rehabilitation and quality of life.
脑卒中后抑郁（PSD）的发病率为 20%至 65%，是脑卒中的常见后遗症。本研究旨在确定脑卒中后 18 个月 PSD 的发生率和危险因素。
作为 Middelheim 多学科卒中研究的一部分，对前瞻性纵向流行病学研究中的患者进行了 18 个月的随访。采用 Cornell 抑郁量表（CSD）和 Montgomery-Åsberg 抑郁评定量表（MADRS）定量评估 PSD 的临床显著症状和体征。采用卒中影响量表（SIS）测量活动情况，包括社会活动。通过问卷定义脑卒中后出现的关系问题。
完成随访评估的 125 例患者进行了数据分析。28%的患者被诊断为抑郁（CSD 评分≥8）。与无 PSD 的患者相比，PSD 患者的日常生活活动能力更依赖，且存在更多的躯体和认知障碍。当 SIS 评分增加一个单位时，患者出现抑郁的风险降低 5%（优势比（OR）=0.95；95%置信区间（CI）=0.93-0.97）。与脑卒中后持续存在关系问题的患者相比，无关系问题的患者发生抑郁的风险约高 4.5 倍（OR=4.48；95%CI=1.17-16.87）。
多元回归模型表明，脑卒中后 18 个月发生 PSD 的最主要决定因素包括活动减少和脑卒中导致的关系问题。进一步研究 PSD 的危险因素非常重要，包括心理社会因素，因为其对康复和生活质量有负面影响。
