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Published on: May 22, 2019
Depressed mood after intracerebral hemorrhage: the FAST trial
Michael C Christensen1, Stephan A Mayer, Jean-Marc Ferran
1Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark. mcrc@novonordisk.com
Insights
Approximately 20% of intracerebral hemorrhage (ICH) survivors experience depressed mood, negatively impacting their quality of life (QoL). Early identification and treatment of depression are crucial for stroke survivors to improve outcomes.
Area of Science:
- Neurology
- Psychiatry
- Public Health
Background:
- Depression is a common complication following stroke.
- Limited data exist on depression prevalence and its impact on quality of life (QoL) in intracerebral hemorrhage (ICH) survivors.
Purpose of the Study:
- To determine the prevalence of depressed mood 90 days after ICH.
- To investigate the relationship between depressed mood and QoL in ICH survivors.
Main Methods:
- Utilized data from the Factor Seven for Acute Hemorrhagic Stroke (FAST) trial.
- Assessed depressed mood using the Hamilton Depression Rating Scale (HDRS) and QoL with the EuroQoL at 90 days post-ICH.
- Employed multivariate logistic regression and Spearman correlation to analyze predictors and relationships.
Main Results:
- 20% of ICH survivors reported depressed mood (HDRS >10) at 90 days.
- Predictors of depressed mood included comorbidities, neurological impairment (NIHSS), physical disability (Barthel Index), and female gender.
- Depressed mood severity significantly correlated with poorer QoL, regardless of disability levels.
Conclusions:
- Depressed mood is prevalent in approximately 20% of ICH survivors and significantly impairs QoL.
- Healthcare providers should actively monitor and treat depression in ICH survivors, especially those with chronic illness or severe impairment.
Background And Purpose:
Depression is a frequent and important complication of stroke. Few data exist on the prevalence of depression/depressed mood after intracerebral hemorrhage (ICH) and the relationship between depression/depressed mood and the quality of life (QoL) more generally experienced by survivors of ICH.
Methods:
Factor Seven for Acute Hemorrhagic Stroke (FAST) was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. All patients were evaluated at day 90 after ICH onset for depressed mood and QoL with the Hamilton Depression Rating Scale (HDRS) and the EuroQoL, respectively. Multivariate stepwise logistic regression was used to develop a predictive model for depressed mood at day 90. Relationships between HDRS and EuroQoL scores at day 90 were evaluated with Spearman correlation coefficients.
Results:
657 patients were alive at 3 months after ICH onset; 596 (91%) completed the HDRS. Twenty percent reported an HDRS score >10, indicating at least a minor degree of depressed mood; 6% endorsed symptoms of severely depressed mood. Significant predictors of depressed mood included comorbidities (p = 0.0022), moderate to severe neurological impairment according to the National Institutes of Health Stroke Scale (NIHSS) at day 15 (p = 0.0097), physical disability as measured by the Barthel Index (BI) at day 15 (p = 0.0486), and female gender (p = 0.04), but not hemorrhage severity or a history of depression. Irrespective of the presence of post-ICH disability and impairment, the severity of depressed mood at day 90 was significantly correlated with poor QoL.
Conclusion:
Depressed mood affects approximately 20% of ICH survivors and adversely affects QoL. Physicians should be vigilant to ensure that chronically ill and severely impaired survivors of ICH are adequately monitored and treated for depression after ICH.
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