Depression after stroke: natural history, predictors and associations with other health outcomes

Introduction: Stroke is a leading cause of mortality and disability worldwide. There is limited evidence on the natural history, predictors, and outcomes of depression in the long term after stroke.<br/><br/>Objectives:<br/>-To describe the natural history of depression within 15 years of stroke<br/>-To identify the predictors of depression within 15 years of stroke.<br/>-To identify the health outcomes of post-stroke depression.<br/><br/>Methods: A systematic review and meta-analysis of studies of the natural history, predictors and associated outcomes of post-stroke depression was conducted.<br/>Incidence, prevalence, cumulative incidence, time of onset, duration, and recurrence of depression, within 15 years of stroke were estimated in the population based South London Stroke Register (SLSR).<br/>Predictors and outcomes of depression up to 15 years after stroke were identified.<br/><br/>Results: The systematic review identified 49 studies. The pooled prevalence of depression was 29%. The major predictors of depression included disability and history of depression pre-stroke. The main outcomes of depression were lower quality of life and disability.<br/>The SLSR data analyses showed that the prevalence of depression was around 30% and remained stable within 15 years of stroke, with an annual incidence 7 to 21% and cumulative incidence of 55%.<br/><br/>Depression started shortly after stroke, had a short duration and high recurrence rate.<br/>Variables associated with depression included stroke severity, disability at baseline, depression before stroke, together with disability, social isolation, and cognitive impairment at follow-up. Depression was associated with mortality, disability, cognitive impairment and lower quality of life at follow-up.<br/><br/>Conclusion: depression is a frequent chronic and recurrent condition after stroke, with higher risk among patients with previous depression and after severe strokes, and it is associated with negative health outcomes in the long term.

Name dc:type.qualificationname

Doctor of Philosophy

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

King's College London

Year dc:date.issued

2014

Author dc:creator

• Ayerbe Garcia-Monzon, Luis

Advisors dc:contributor.advisor

• Rudd, Anthony
• Wolfe, Charles David Alexander

Language dc:language

eng

Identifier

oai:kclpure.kcl.ac.uk:studenttheses/91020101-6f9f-458f-b690-d917ef1c8210

OAI identifier oai:identifier

oai:kclpure.kcl.ac.uk:studenttheses/91020101-6f9f-458f-b690-d917ef1c8210