Increased Risk of Developing Depression in Disability after Stroke: A Korean Nationwide Study

Stroke is a leading cause of mortality and a major cause of disability worldwide. A significant number of stroke survivors suffer from depression, impeding the activities of daily living and rehabilitation. Here, we examined the risk of depression among stroke survivors according to the severity of disabilities and compared its incidence with a matched control group. We included data from the Korean National Health Insurance Service of 207,678 stroke survivors. Cox proportional hazard models were used to calculate the risk of depression among stroke survivors. Stroke survivors had a greater risk of developing depression than the matched control group with an adjusted hazard ratio of 2.12 (95% confidence interval 2.09-2.15). Stroke survivors with more severe disabilities were associated with a higher risk of depression than those with mild disabilities. The risk of developing depression was prominently high within the first year after a stroke. Males and younger people (<65 years) were independent risk factors for depression in stroke survivors. This study demonstrated an increased risk of developing depression in stroke survivors compared to control subjects, and a higher risk of depression was associated with a more severe degree of disability. Clinicians should be aware of the risk of depression developing in stroke survivors, especially those with disabilities.