PAPER

A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction

I Aben¹, F Verhey¹, J Strik¹, R Lousberg¹, J Lodder² and A Honig¹

¹ Department of Psychiatry and Neuropsychology, Institute Brain and Behaviour, University of Maastricht, Maastricht, Netherlands
² Department of Neurology, Institute Brain and Behaviour, University of Maastricht

Correspondence to:
Correspondence to:
Professor Frans R J Verhey, Department of Psychiatry and Neuropsychology, Institute of Brain and Behaviour, Maastricht University/University Hospital of Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands;
f.verhey{at}np.unimaas.nl

Background: The high incidence of post-stroke depression has been claimed to reflect a specific, stroke related pathogenesis in which lesion location plays an important role. To substantiate this claim, post-stroke depression should occur more often than depression after another acute, life threatening, disabling disease that does not involve cerebrovascular damage.

Objectives: To compare the cumulative one year incidence of depression after stroke and after myocardial infarction, taking into consideration differences in age, sex, and the level of handicap.

Methods: In a longitudinal design, 190 first ever stroke patients and 200 first ever myocardial infarction patients were followed up for one year. Depression self rating scales were used as a screening instrument to detect patients with depressive symptoms. Major and minor depression was assessed at one, three, six, nine, and 12 months after stroke or myocardial infarction according to DSM-IV criteria, using the structured clinical interview from DSM-IV. The severity of depressive symptoms was measured with the Hamilton depression rating scale. Level of disability and handicap was rated with the Rankin handicap scale.

Results: The cumulative one year incidence of major and minor depression was 37.8% in stroke patients and 25% in patients with myocardial infarction (hazard ratio 1.6; p = 0.06). This difference disappeared after controlling for sex, age, and level of handicap. In addition, no differences were found in the severity of depressive symptoms or in the time of onset of the depressive episode after stroke or myocardial infarction.

Conclusions: Depression occurs equally often during the first year after stroke and after myocardial infarction when non-specific factors such as sex, age, and level of handicap are taken into account. Thus the relatively high incidence of post-stroke depression seems not to reflect a specific pathogenic mechanism. Further research is needed to investigate whether vascular factors play a common role in the development of depression after stroke and myocardial infarction.

Keywords: depression; stroke; myocardial infarction

Abbreviations: BDI, Beck depression inventory; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition; FAST, Frenchay aphasia screening test; HADS, hospital anxiety and depression scale; HAM-D, Hamilton depression rating scale; HR, hazard ratio; MMSE, mini-mental state examination; SCID-I-R, structured clinical interview from DSM-IV; SCL-90, 90 item symptom checklist

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