Gender and stress in predicting depressive symptoms following stroke

Post-stroke depression (PSD) is associated with poor clinical and functional outcomes, and women are likely to experience PSD more than men. Although stress is related to depression, and women report greater emotional reactivity to stressful life events, the link between stress and gender is yet to be examined relative to PSD. Further, electronic momentary assessment (EMA), a mobile technology, has not been used to assess stressful life events and PSD in real time and in the natural environments of daily life. The purpose of the current study was to examine gender differences in the relationship of stress and PSD using EMA.

Individuals admitted to the Stroke Center at the University of Bordeaux were contacted for participation in a prospective study of symptoms and experiences in daily life using ambulatory monitoring. Forty-three post-stroke patients (47% female) completed electronic assessments of life events, perceived stress, and depressive symptoms (i.e., sad mood, anhedonia, fatigue, concentration difficulties, appetite change, negative thoughts, hopelessness) during their daily life for one week. Patients also completed a clinician-administered standardized depression scale at baseline and three-month follow-up.

Using EMA, participants responded to 83.7% of the electronic interviews for a total of 1,140 observations across diverse daily life contexts. Stressful events of any degree of negativity were reported at over one-third (37.3%) of all EMA assessments. The severity of depressive symptoms as assessed in daily life through EMA was greater in women following stroke than in men. Further, there was a significant association between EMA-assessed depressive symptoms and daily life stress for women, but not men. This association was due primarily to three specific depressive symptoms: sad mood, fatigue, and appetite change. No difference was observed between men and women in standardized depression assessments administered during clinic visits at baseline or three-month follow-up.

Greater reactivity to stressful life events and a link between stress reactivity and depressive symptoms were found in female as compared to male post-stroke patients. Gender differences in depressive symptoms were identified using EMA data collected during daily life as contrasted with the use of a standard assessment during clinic visits. Mobile technologies may help to identify important real-time behaviors and symptoms that are not observable by standard clinical assessments employed at regular clinic visits. Further, future research should examine the overall and gender-specific benefits of stress-based interventions to reduce the risk of PSD for adults.