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Published on: May 22, 2019
A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction
1Department of Psychiatry and Neuropsychology, Institute Brain and Behaviour, University of Maastricht, Maastricht, Netherlands.
Insights
Post-stroke depression occurs at similar rates to depression after myocardial infarction when accounting for patient factors. This suggests non-specific mechanisms, not stroke-specific ones, may drive depression incidence.
Area of Science:
- Neurology
- Cardiology
- Psychiatry
Background:
- Post-stroke depression incidence is high, with theories suggesting stroke-specific pathogenesis linked to lesion location.
- Investigating stroke-related depression requires comparison with other severe, disabling conditions without cerebrovascular damage.
Purpose of the Study:
- To compare the one-year incidence of depression following stroke versus myocardial infarction.
- To account for confounding factors like age, sex, and handicap level in the comparison.
Main Methods:
- Longitudinal study of 190 first-ever stroke patients and 200 first-ever myocardial infarction patients over one year.
- Utilized DSM-IV criteria and structured clinical interviews for depression assessment (major/minor).
- Measured depressive symptom severity (Hamilton Depression Rating Scale) and disability (Rankin Handicap Scale).
Main Results:
- Cumulative one-year depression incidence was 37.8% post-stroke vs. 25% post-myocardial infarction (HR 1.6, p=0.06).
- This difference vanished after adjusting for sex, age, and handicap.
- No significant differences were observed in depressive symptom severity or onset timing.
Conclusions:
- Depression incidence is comparable in the first year after stroke and myocardial infarction when non-specific factors are controlled.
- The high rate of post-stroke depression may not stem from a stroke-specific pathogenic mechanism.
- Further research is warranted to explore potential shared vascular factors in depression development after these conditions.
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.
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