Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI.
Health Services Research and Development Center for Health Information and Communication Roudebush VA Medical Center Indianapolis IN.
J Am Heart Assoc. 2021 Jul 6;10(13):e020494. doi: 10.1161/JAHA.120.020494. Epub 2021 Jun 29.
Background This study examined the prevalence and longitudinal course of depression during the first year after mild to moderate stroke. Methods and Results We identified patients with mild to moderate ischemic stroke or intracerebral hemorrhage (National Institutes of Health Stroke Scale score <16) and at least 1 depression assessment at 3, 6, or 12 months after stroke (n=648, 542, and 533, respectively) from the Brain Attack Surveillance in Corpus Christi project (2014-2016). Latent transition analysis was used to examine temporal profiles of depressive symptoms assessed by the 8-item Patient Health Questionnaire between 3 and 12 months after stroke. Mean age was 65.6 years, 49.4% were women, and 56.7% were Mexican Americans. The prevalence of depression after stroke was 35.3% at 3 months, decreased to 24.9% at 6 months, and remained stable at 25.7% at 12 months. Approximately half of the participants classified as having depression at 3 or 6 months showed clinical improvement at the next assessment. Subgroups with distinct patterns of depressive symptoms were identified, including mild/no symptoms, predominant sleep disturbance and fatigue symptoms, affective symptoms, and severe/all symptoms. A majority of participants with mild/no symptoms retained this symptom pattern over time. The probability of transitioning to mild/no symptoms was higher before 6 months compared with the later period, and severe symptoms were more likely to persist after 6 months compared with the earlier period. Conclusions The observed dynamics of depressive symptoms suggest that depression after stroke tends to persist after 6 months among patients with mild to moderate stroke and should be continually monitored and appropriately managed.
背景 本研究调查了轻度至中度中风后第一年期间抑郁的患病率和纵向病程。
方法和结果 我们从 Brain Attack Surveillance in Corpus Christi 项目（2014-2016 年）中确定了 NIHSS 评分＜16 的轻度至中度缺血性中风或脑出血患者，并在中风后 3、6 或 12 个月至少进行了 1 次抑郁评估（分别为 648、542 和 533 例）。使用潜在转变分析来检查中风后 3 至 12 个月间通过 8 项 PHQ 评估的抑郁症状的时间分布。平均年龄为 65.6 岁，49.4%为女性，56.7%为墨西哥裔美国人。中风后 3 个月的抑郁患病率为 35.3%，6 个月时降至 24.9%，12 个月时稳定在 25.7%。大约一半在 3 或 6 个月时被诊断为抑郁的参与者在下一次评估中显示出临床改善。确定了具有不同抑郁症状模式的亚组，包括轻度/无症状、主要睡眠障碍和疲劳症状、情感症状和严重/所有症状。大多数有轻度/无症状的参与者随着时间的推移保留了这种症状模式。与后期相比，在 6 个月之前，向轻度/无症状转变的可能性更高，与早期相比，6 个月后严重症状更可能持续存在。
结论 观察到的抑郁症状动态表明，轻度至中度中风患者在 6 个月后，中风后抑郁往往持续存在，应持续监测并进行适当管理。
