Department of Psychiatry, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Rehabilitation Research Institute of Singapore, 11 Mandalay Road #14-03/04, Clinical Sciences Building, Singapore 308232.
J Stroke Cerebrovasc Dis. 2024 Feb;33(2):107509. doi: 10.1016/j.jstrokecerebrovasdis.2023.107509. Epub 2023 Dec 15.
Studies of poststroke depression (PSD) in Singapore are limited. Specifically, the dynamic epidemiology and phenomenology of PSD in the different stroke types are unknown.
This study aims to characterize the epidemiology and phenomenology of PSD in both the hospital setting, and in the community setting up to one year after stroke.
Real-world clinical data of 1732 consecutive stroke patients in a tertiary stroke centre was extracted from inception in January 2010 to 30 November 2021. The Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ) were used to identify PSD. Demographic, comorbidities and stroke-related variables, and stroke severity were extracted and analysed by stroke type - ischemic, haemorrhagic, and strategic, at the hospitalisation and community follow-up cross-sections. For each group, the characteristics of those with PSD were compared against those without PSD. Logistic regression was performed to identify PSD predictors. Phenomenology was mapped by the relative frequencies of endorsed items on PHQ and HADS in PSD patients.
The prevalence of in-hospital PSD was 19.24 % in ischemic stroke, and 24.59 % in both haemorrhagic strokes and strategic basal ganglia/thalamus strokes. Prevalence of PSD in 547 stroke patients who were followed-up ≤ 12 months was 6.42 % in ischemic strokes, 3.52 % in haemorrhagic strokes and 5.23 % among strategic strokes. The association of right sided, bilateral strokes, strategic strokes, and large vessel aetiology with PSD only exists for ischemic strokes. Greater functional impairment and a past psychiatric history are independent predictive factors of PSD in all stroke types. Symptom profile of in-hospital PSD includes anxious distress.
These findings have immediate clinical applicability considering the representativeness of the study sample.
新加坡针对脑卒中后抑郁（PSD）的研究有限。具体来说，不同脑卒中类型的 PSD 的动态流行病学和表现仍不清楚。
本研究旨在描述脑卒中后 1 年内在医院和社区环境中 PSD 的流行病学和表现。
从 2010 年 1 月至 2021 年 11 月 30 日，从一家三级脑卒中中心提取了 1732 例连续脑卒中患者的真实世界临床数据。采用医院焦虑抑郁量表（HADS）和患者健康问卷（PHQ）来识别 PSD。提取并分析人口统计学、合并症和与脑卒中相关的变量以及脑卒中严重程度，按脑卒中类型（缺血性、出血性和策略性）在住院和社区随访时进行分析。对于每个组，将 PSD 患者与非 PSD 患者的特征进行比较。采用逻辑回归识别 PSD 的预测因素。通过 PSD 患者 PHQ 和 HADS 中阳性项目的相对频率来映射表现。
缺血性脑卒中住院 PSD 的患病率为 19.24%，出血性脑卒中及策略性基底节/丘脑脑卒中的患病率为 24.59%。547 例随访时间≤12 个月的脑卒中患者中，缺血性脑卒中 PSD 的患病率为 6.42%，出血性脑卒中为 3.52%，策略性脑卒中为 5.23%。右侧、双侧脑卒中、策略性脑卒中以及大血管病因与 PSD 相关的关联仅存在于缺血性脑卒中。功能障碍程度更大和既往精神病史是所有脑卒中类型 PSD 的独立预测因素。住院 PSD 的症状特征包括焦虑困扰。
鉴于研究样本的代表性，这些发现具有直接的临床应用价值。
