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Poststroke depression: Prevalence, course, and associated factors

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Abstract

Despite the considerable amount of research that has been undertaken on poststroke depression, a review of the literature demonstrates that there are many inconclusive findings in the area. In particular, the causes and course of the disorder remain to be firmly established. While studies of prevalence differ with respect to the nature and timing of their assessment procedures, most conclude that poststroke depression has a negative impact on the rehabilitation of the stroke patient. Very little research is available on the relationship between poststroke depression and care-giver burden. However, recent studies have adopted more rigorous methodological procedures, allowing some insights into the complex mixture of factors which determine the occurrence of poststroke depression.

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References

  • Agrell, B., and Dehlin, O. (1989). Comparison of six depression rating scales in geriatric stroke patients.Stroke 20: 1190–1194.

    Google Scholar 

  • Allman, P., Hope, T., and Fairburn, C. G. (1992). Crying following stroke: A report on 30 cases.General Hospital Psychiatry 14: 315–321.

    Google Scholar 

  • Andersen, G., Vestergaard, K., and Lauritzen, L. (1994). Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram.Stroke 25: 1099–1104.

    Google Scholar 

  • Andersen, G., Vestergaard, K., and Riis, J. O. (1993). Citalopram for post-stroke pathological crying.Lancet 342: 837–839.

    Google Scholar 

  • Andersen, G., Vestergaard, K., Riis, J. O., and Lauritzen, L. (1994). Incidence of post-stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale.ACTA Psychiatrica Scandinavica 90: 190–195.

    Google Scholar 

  • Anderson, R. (1992).The Aftermath of Stroke: The Experience of Patients and Their Families, Cambridge University Press, Cambridge.

    Google Scholar 

  • Angeleri, F., Angeleri, V. A., Foschi, N., Giaquinto, S., and Nolfe, G. (1993). The influence of depression, social activity, and family stress on functional outcome after stroke.Stroke 24: 1478–1483.

    Google Scholar 

  • Antonuccio, D. O., Danton, W. G., and DeNelsky, G. Y. (1995). Psychotherapy versus medication for depression: Challenging the conventional wisdom with data.Professional Psychology: Research and Practice 26: 574–585.

    Google Scholar 

  • Astrom, M., Adolfsson, R., and Asplund, K. (1993). Major depression in stroke patients: A 3-year longitudinal study.Stroke 24: 976–982.

    Google Scholar 

  • Astrom, M., Asplund, K., and Astrom, T. (1992). Psychosocial function and life satisfaction after stroke.Stroke 23: 527–531.

    Google Scholar 

  • Astrom, M., Olsson, T., and Asplund, K. (1993). Different linkage of depression to hypercortisolism early versus late after stroke: A 3-year longitudinal study.Stroke 24: 52–57.

    Google Scholar 

  • Barry, S., Phillips, O. M., Williams, D. S., and Dinan, T. G. (1990). Platelet 5-HT uptake in post-stroke depression.ACTA Psychiatrica Scandinavica 82: 88–89.

    Google Scholar 

  • Burke, W. J., Nitcher, R. L., Roccaforte, W. H., and Wengel, S. P. (1992). A prospective evaluation of the Geriatric Depression Scale in an outpatient geriatric assessment center.Journal of the American Geriatrics Society 40: 1227–1230.

    Google Scholar 

  • Davison, G. C., and Neale, J. M. (1990).Abnormal Psychology (5th ed.), John Wiley and Sons, New York.

    Google Scholar 

  • Draper, B. M., Poulos, C. J., Cole, A. M. D., Poulos, R. G., and Ehrlich, F. (1992). A comparison of caregivers for elderly stroke and dementia victims.Journal of the American Geriatric Society 40: 896–901.

    Google Scholar 

  • Falconer, J. A., Naughton, B. J., Strasser, D. C., and Sinacore, J. M. (1994). Stroke inpatient rehabilitation: A comparison across age groups.Journal of the American Geriatric Society 42: 39–44.

    Google Scholar 

  • Fedoroff, J. P., Starkstein, S. E., Parikh, R. M., Price, T. R., and Robinson, R. G. (1991). Are depressive symptoms nonspecific in patients with acute stroke?.American Journal of Psychiatry 48: 1172–1176.

    Google Scholar 

  • Fischer, J., and Corcoran, K. (1994).Measures for Clinical Practice: A Sourcebook (2nd ed.), Free Press, New York.

    Google Scholar 

  • Gainotti, G. (1992). Post-stroke depression: Psychological and biochemical interpretations. In von Steinbuchel, N., van Cramon, D. Y., and Poppel, E. (eds.),Neuropsychological Rehabilitation, Springer-Verlag, New York, pp. 215–225.

    Google Scholar 

  • Gass, C. S., and Lawhorn, L. (1991). Psychological adjustment following stroke: An MMPI study.Psychological Assessment 3: 628–633.

    Google Scholar 

  • Gladman, J. R. F., Lincoln, N. B., and Barer, D. H. (1993). A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital.Journal of Neurology, Neurosurgery, and Psychiatry 56: 960–966.

    Google Scholar 

  • Gompertz, P., Pound, P., and Ebrahim, S. (1993). The reliability of stroke outcome measures.Clinical Rehabilitation 7: 290–296.

    Google Scholar 

  • Grasso, M. G., Pantano, P., Ricci, M., Intiso, D. F., Pace, A., Padovani, A., Orzi, F., Prozzilli, C., and Lenzi, G. L. (1994). Mesial temporal cortex hypoperfusion is associated with depression in subcortical stroke.Stroke 25: 980–985.

    Google Scholar 

  • Greveson, G. C., Gray, C. S., French, J. M., and James, O. F. W. (1991). Long-term outcome for patients and carers following hospital admission for stroke.Age and Ageing 20: 337–344.

    Google Scholar 

  • Haley, W. E., Levine, E. G., Brown, S. L., and Bartolucci, A. A. (1987). Stress, appraisal, coping and social support as predictors of adaptational outcome among dementia caregivers.Psychology and Aging 2: 323–330.

    Google Scholar 

  • Heilman, K. M., Bowers, D., and Valenstein, E. (1993). Emotional disorders associated with neurological diseases. In Heilman, K. M., and Valenstein, E. (eds.),Clinical Neuropsychology, Oxford University Press, New York, pp. 461–497.

    Google Scholar 

  • Herrmann, M., Bartels, C., Schumacher, M., and Wallesch, C. (1995). Poststroke depression: Is there a pathoanatomic correlate for depression in the postacute stage of stroke?Stroke 26: 850–856.

    Google Scholar 

  • Herrmann, M., Bartels, C., and Wallesch, C. W. (1993). Depression in acute and chronic aphasia: Symptoms, pathoanatomical-clinical correlations and functional implications.Journal of Neurology, Neurosurgery, and Psychiatry 56: 672–678.

    Google Scholar 

  • House, A., Dennis, M., Mogridge, L., Warlow, C., Hawton, K., and Jones, L. (1991). Mood disorders in the year after first stroke.British Journal of Psychiatry 158: 83–92.

    Google Scholar 

  • Jacobson, N. S., and Hollon, S. D. (1996). Prospects for future comparisons between drugs and psychotherapy: Lessons from the CBT-versus-pharmacotherapy exchange.Journal of Consulting and Clinical Psychology 64: 104–108.

    Google Scholar 

  • Johnson, G. A. (1991). Research into psychiatric disorder after stroke: The need for further studies.Australian and New Zealand Journal of Psychiatry 25: 358–370.

    Google Scholar 

  • Kelly-Hayes, M., and Paige, C. (1995). Assessment and psychologic factors in stroke rehabilitation.Neurology 45 (Suppl. 1): S29-S32.

    Google Scholar 

  • Larner, S. L., and Leeming, J. T. (1984). The work of a clinical psychologist in the care of the elderly.Age and Ageing 13: 29–33.

    Google Scholar 

  • Lazarus, L. W., Moberg, P. J., Langsley, P. R., and Lingam, V. R. (1994). Methylphenidate and nortriptyline in the treatment of poststroke depression: A retrospective comparison.Archives of Physical and Medical Rehabilitation 75: 403–406.

    Google Scholar 

  • Lezak, M. D. (1995).Neuropschological assessment (3rd ed.). Oxford, New York.

    Google Scholar 

  • McDowell, I., and Newell, C. (1987).Measuring Health: A Guide to Rating Scales and Questionnaires, Oxford, New York.

    Google Scholar 

  • McGivney, S. A., Mulvihill, M., and Taylor, B. (1994). Validating the GDS depression screen in the nursing home.Journal of the American Geriatric Society 42: 490–492.

    Google Scholar 

  • Morris, P. L. P., Raphael, B., and Robinson, R. G. (1992). Clinical depression is associated with impaired recovery from stroke.The Medical Journal of Australia 157: 239–242.

    Google Scholar 

  • Morris, P. L. P., Robinson, R. G., Andrzejewski, P., Samuels, J., and Price, T. R. (1993). Association of depression with 10-year poststroke mortality.American Journal of Psychiatry 150: 124–129.

    Google Scholar 

  • Morris, P. L. P., Robinson, R. G., and Samuels, J. (1993). Depression, introversion and mortality following stroke.Australian and New Zealand Journal of Psychiatry 27: 443–449.

    Google Scholar 

  • Morris, P. L. P., Robinson, R. G., and Raphael, B. (1993). Emotional lability after strokeAustralian and New Zealand Journal of Psychiatry 27: 601–605.

    Google Scholar 

  • Morris, P. L. P., Robinson, R. G., Raphael, B., Samuels, J., and Molloy, P. (1992). The relationship between risk factors for affective disorder and poststroke depression in hospitalized stroke patients.Australian and New Zealand Journal of Psychiatry 26: 208–217.

    Google Scholar 

  • Mullen, P. E., Linsell, C. R., and Parker, D. (1986). Influence of sleep disruption and calorie restriction on biological markers for depression.Lancet ii: 1051–1056.

    Google Scholar 

  • Nelson, L. D., Cicchetti, D., Satz, P., Sowa, M., and Mitrushina, M. (1994). Emotional sequelae of stroke: A longitudinal perspective.Journal of Clinical and Experimental Neuropsychology 16: 796–806.

    Google Scholar 

  • Norman, T. R., Judd, F. K., and Burrows, G. D. (1992). New pharmacological approaches to the management of depression: From theory to clinical practice.Australian and New Zealand Journal of Psychiatry 26: 73–81.

    Google Scholar 

  • Parikh, R. M., Lipsey, J. R., Robinson, R. G., and Price, T. R. (1987). Two-year longitudinal study of post-stroke mood disorders: Dynamic changes in correlates of depression at one and two years.Stroke 18: 579–584.

    Google Scholar 

  • Parikh, R. M., Robinson, R. G., Lipsey, J. R., Starkstein, S. E., Fedoroff, J. P., and Price, T. R. (1990). The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up.Archives of Neurology 47: 785–789.

    Google Scholar 

  • Price, T. R. (1990). Affective disorders after stroke.Stroke 21: 12–13.

    Google Scholar 

  • Rehm, L. P. (1988). Assessment of depression. In A. S. Bellack, and M. Hersen (eds.),Behavioral Assessment: A Practical Handbook (3rd ed.), Pergamon Press, New York, pp. 313–364.

    Google Scholar 

  • Robinson, R. G., Bolduc, P. L., and Price, T. R. (1987). A two-year longitudinal study of post-stroke mood disorders: Diagnosis and outcome at one and two years.Stroke 18: 837–843.

    Google Scholar 

  • Robinson, R. G., and Price, T. R. (1982). Post-stroke depressive disorders: A follow-up study of 103 patients.Stroke 13: 635–641.

    Google Scholar 

  • Robinson, R. G., Starr, L. B., Kubos, K. L., and Price, T. R. (1983). A two-year longitudinal study of post-stroke mood disorders: Findings during the initial evaluation.Stroke 14: 736–741.

    Google Scholar 

  • Robinson, R. G., Starr, L. B., Lipsey, J. R., Rao, K., and Price, T. R. (1984). A two-year longitudinal study of post-stroke mood disorders: Dynamic changes in associated variables over the first six months of follow-up.Stroke 15: 510–517.

    Google Scholar 

  • Robinson, R. G., Starr, L. B., and Price, T. R. (1984). A two-year longitudinal study of mood disorders following stroke: Prevalence and duration at six months follow-up.British Journal of Psychiatry 144: 256–262.

    Google Scholar 

  • Sandin, K. J., Cifu, D. X., and Noll, S. F. (1994). Stroke rehabilitation 4: Psychologic and social implications.Archives of Physical and Medical Rehabilitation 75: S52-S55.

    Google Scholar 

  • Schubert, D. S. P., Burns, R., Paras, W., and Sioson, E. (1992). Decrease of depression during stroke and amputation rehabilitation.General Hospital Psychiatry 14: 135–141.

    Google Scholar 

  • Schubert, D. S. P., Taylor, D., Lee, D. O. S., Mentari, A., and Tamaklo, W. (1992). Physical consequences of depression in the stroke patients.General Hospital Psychiatry 14: 69–76.

    Google Scholar 

  • Schwartz, J. A., Speed, N. M., Mountz, J. M., Gross, M. D., Dell, J. G., and Kuhl, D. E. (1990).99mTc-Hexamethylpropyleneamine oxime single photon emission CT in poststroke depression.American Journal of Psychiatry 147: 242–244.

    Google Scholar 

  • Sharpe, M., Hawton, K., Seagroatt, V., Bamford, J., House, A., Molyneux, A., Sandercock, P., and Warlow, C. (1994). Depressive disorders in long-term survivors of stroke: Associations with demographic and social factors, functional status, and brain lesion volume.British Journal of Psychiatry 164: 380–386.

    Google Scholar 

  • Shaver, P. R., and Brennan, K. A. (1991). Measures of depression and loneliness. In J. P. Robinson, P. R. Shaver, and L. S. Wrightsman (eds.).Measures of Personality and Social Psychological Attitudes, Academic Press, San Diego, CA.

    Google Scholar 

  • Shima, S., Kitagawa, Y., Kitamura, T., Fujinawa, A., and Watanabe, Y. (1994). Poststroke depression.General Hospital Psychiatry 16: 286–289.

    Google Scholar 

  • Skilbeck, C. (1992). Neuropsychological assessment in stroke. In Crawford, J. R., Parker, D. M., and McKinlay, W. W. (eds.),A Handbook of Neuropsychological Assessment, Lawrence Erlbaum, Hove, UK, pp. 339–361.

    Google Scholar 

  • Sloan, R. L., Brown, K. W., and Pentland, B. (1992). Fluoxetine as a treatment for emotional lability after brain injury.Brain Injury 6: 315–319.

    Google Scholar 

  • Starkstein, S. E., Cohen, B. S., Fedoroff, P., Parikh, R. M., Price, T. R., and Robinson, R. G. (1990). Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury.Archives of General Psychiatry 47: 246–251.

    Google Scholar 

  • Stern, R. A., and Bachman, D. L. (1991). Depressive symptoms following stroke.American Journal of Psychiatry 148: 351–356.

    Google Scholar 

  • Tatemichi, T. K., Desmond, D. W., Stern, Y., Paik, M., Sano, M., and Bagiella, E. (1994). Cognitive impairment after stroke: Frequency, patterns, and relationship to functional abilities.Journal of Neurology, Neurosurgery, and Psychiatry, 57: 202–207.

    Google Scholar 

  • Thompson, S. C., Bundek, N. I., and Sobolew-Shubin, A. (1990). The caregivers of stroke patients: An investigation of factors associated with depression.Journal of Applied Social Psychology 20: 115–129.

    Google Scholar 

  • Tyman, R. V. (1994). The stress experienced by caregivers of stroke survivors: Is it all in the mind, or is it also in the body?Clinical Rehabilitation 8: 341–345.

    Google Scholar 

  • Yamaguchi, S., Kobayashi, S., Koide, H. and Tsunematsu, T. (1992). Longitudinal study of regional cerebral blood flow changes in depression after stroke.Stroke 23: 1716–1722.

    Google Scholar 

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Hosking, S.G., Marsh, N.V. & Friedman, P.J. Poststroke depression: Prevalence, course, and associated factors. Neuropsychol Rev 6, 107–133 (1996). https://doi.org/10.1007/BF01874894

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