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Effective Tools to Predict Depression in Acute and Subacute Phase of Ischemic Stroke
Katsunaka Mikami1, Takeshi Sudo1, Yasushi Orihashi1
1Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson).
Objective:
Despite the high frequency of depression in the first year following stroke, few studies have predicted risk of depression after the acute and subacute stroke periods. The aim of this study was to identify, in the acute and subacute periods, measures that would predict major depression during the first year after stroke.
Methods:
Study subjects were inpatients with ischemic stroke aged 20-85 years within 6 weeks of onset. Patients were evaluated at baseline and at 3, 6, 9, and 12 months. Patients were diagnosed with major depression using the Structured Clinical Interview for DSM-IV. The severity of depressive symptoms was measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MADRS).
Results:
Of the 152 potential patients who met inclusion criteria, 49 had follow-up evaluations; one patient with major depression in the acute and subacute periods was excluded from the analysis. Among the remaining 48 patients, the number of those with major depression during the first year of stroke onset was five (10.4%). Patients who developed major depression had significantly more depressive symptoms in the acute and subacute stroke phase as assessed by both the PHQ-9 and MADRS. Patients with PHQ-9 scores ≥9 in the acute and subacute stroke phases were significantly more likely to develop major depression in a chronic phase of stroke.
Conclusions:
The self-administered PHQ-9 can identify patients in the acute and subacute stroke periods who are at increased risk for developing major depression during the first year after stroke.
