Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson).
J Neuropsychiatry Clin Neurosci. 2021 Winter;33(1):43-48. doi: 10.1176/appi.neuropsych.20040076. Epub 2020 Oct 22.
Despite the high frequency of depression in the first year following stroke, few studies have predicted risk of depression after the acute and subacute stroke periods. The aim of this study was to identify, in the acute and subacute periods, measures that would predict major depression during the first year after stroke.
Study subjects were inpatients with ischemic stroke aged 20-85 years within 6 weeks of onset. Patients were evaluated at baseline and at 3, 6, 9, and 12 months. Patients were diagnosed with major depression using the Structured Clinical Interview for DSM-IV. The severity of depressive symptoms was measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MADRS).
Of the 152 potential patients who met inclusion criteria, 49 had follow-up evaluations; one patient with major depression in the acute and subacute periods was excluded from the analysis. Among the remaining 48 patients, the number of those with major depression during the first year of stroke onset was five (10.4%). Patients who developed major depression had significantly more depressive symptoms in the acute and subacute stroke phase as assessed by both the PHQ-9 and MADRS. Patients with PHQ-9 scores ≥9 in the acute and subacute stroke phases were significantly more likely to develop major depression in a chronic phase of stroke.
The self-administered PHQ-9 can identify patients in the acute and subacute stroke periods who are at increased risk for developing major depression during the first year after stroke.
尽管中风后第一年的抑郁症发病率很高，但很少有研究预测过急性期和亚急性期后发生抑郁症的风险。本研究旨在确定在急性期和亚急性期，哪些指标可以预测中风后一年内的重度抑郁症。
研究对象为发病后 6 周内年龄在 20-85 岁的缺血性中风住院患者。患者在基线和 3、6、9 和 12 个月时进行评估。使用 DSM-IV 定式临床访谈对患者进行重度抑郁症诊断。采用患者健康问卷-9（PHQ-9）和蒙哥马利-Åsberg 抑郁评定量表（MADRS）评估抑郁症状严重程度。
在符合纳入标准的 152 名潜在患者中，有 49 名接受了随访评估；一名在急性期和亚急性期患有重度抑郁症的患者被排除在分析之外。在其余 48 名患者中，有 5 名（10.4%）在中风发病后的第一年患有重度抑郁症。在急性期和亚急性期通过 PHQ-9 和 MADRS 评估，发生重度抑郁症的患者有明显更多的抑郁症状。在急性期和亚急性期 PHQ-9 评分≥9 的患者在中风慢性期发生重度抑郁症的可能性显著更高。
自我评估的 PHQ-9 可以识别出在急性期和亚急性期存在发生重度抑郁症风险的患者，以便在中风后第一年对他们进行早期干预。
