Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Gen Hosp Psychiatry. 2015 May-Jun;37(3):245-50. doi: 10.1016/j.genhosppsych.2015.02.009. Epub 2015 Mar 11.
The purpose of the present study is to evaluate the association between poststroke depression (PSD) and clinical outcomes in first-onset stroke patients who are undergoing a rehabilitation program.
The present study included 180 inpatients that were recruited consecutively and followed up over a 6-month observational period. Poststroke depression was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Symptoms of depression and clinical outcomes were assessed using the Beck Depression Inventory, the modified Barthel Index (MBI) and the Mini Mental State Examination (MMSE). All patients were assessed at baseline and at the end of the 6-month observational period.
Of the 180 patients, 127 (70.6%) were diagnosed with minimal-to-mild depression (MMD), and 53 (29.4%) were diagnosed with moderate-to-severe depression (MSD). The mean change in MBI scores from baseline to 6 months was significantly higher (P=.029) in the MMD group (23.8) than in the MSD group (8.6). The odds ratio for an unfavorable outcome (MBI score <60) in patients with MSD was approximately 3.5 in relation to patients with MMD. The mean change in MMSE score (4.4 versus 7.4) was not significantly different between the MMD and MSD groups.
The present findings suggest that the severity of PSD may be associated with clinical outcomes in Korean patients 6 months after a first-onset stroke. Our data agree with previous findings, which indicate that clinicians should carefully evaluate symptoms of depression in stroke patients during routine clinical practice. The methodological shortcomings of the present study may require further studies with adequate power and improved design to clarify the association between PSD and clinical outcomes following stroke.
本研究旨在评估接受康复计划的首发脑卒中患者中，卒中后抑郁（PSD）与临床结局的相关性。
本研究纳入了 180 例连续入组并在 6 个月观察期内进行随访的住院患者。PSD 的诊断采用《精神障碍诊断与统计手册》第四版的标准。采用贝克抑郁量表（BDI）、改良巴氏指数（MBI）和简易精神状态检查（MMSE）评估抑郁症状和临床结局。所有患者均在基线和 6 个月观察期末进行评估。
180 例患者中，127 例（70.6%）诊断为轻度至中度抑郁（MMD），53 例（29.4%）诊断为中重度抑郁（MSD）。从基线到 6 个月时，MBI 评分的平均变化在 MMD 组（23.8）显著高于 MSD 组（8.6）（P=.029）。MSD 组患者不良结局（MBI 评分＜60）的优势比（OR）约为 MMD 组的 3.5 倍。MMD 和 MSD 组间 MMSE 评分的平均变化（4.4 分比 7.4 分）无显著差异。
本研究结果表明，首发脑卒中后 6 个月时 PSD 的严重程度可能与临床结局相关。我们的数据与之前的研究结果一致，表明临床医生在常规临床实践中应仔细评估脑卒中患者的抑郁症状。本研究方法上的局限性可能需要进一步的研究，以明确 PSD 与脑卒中后临床结局的相关性。
