Poststroke depression severity among older Nigerian adults with confirmed poststroke disabilities: a multisite...

Poststroke depression (PSD) is a prevalent and debilitating complication that adversely affects recovery and quality of life among stroke survivors globally. While PSD prevalence ranges between 28% and 45%, data on severe PSD in older adults with prolonged poststroke disability in Nigeria remain limited. This study aimed to determine the prevalence of severe PSD and identify its key sociodemographic and clinical predictors among older Nigerian adults with chronic poststroke disabilities.

A multisite, hospital-based cross-sectional survey was conducted from March 2024 to July 2025 across six tertiary healthcare institutions representing Nigeria's geopolitical zones. A total of 305 adults aged ≥60 years with physician-confirmed poststroke disabilities were recruited using a multistage sampling technique (stratified purposive hospital selection and consecutive sampling of eligible patients). Depression severity was assessed using the Geriatric Depression Scale-15 (GDS-15). χ² tests evaluated associations between severe depression and predictor variables, with ORs calculated for significant factors (p<0.05).

Severe depression was identified in 66.6% (n=203) of participants, substantially exceeding prior regional estimates. Participants aged ≥70 years had higher odds of severe PSD (OR=1.85; 95% CI 1.07 to 3.21; p=0.01). Female gender was associated with increased depression severity (OR=0.56; 95% CI 0.34 to 0.93; p=0.03). Christian religious affiliation showed a strong positive association (OR=4.30; 95% CI 2.57 to 7.20; p<0.001). Being married (OR=1.82; 95% CI 1.13 to 2.92; p=0.02) and living with family (OR=4.68; 95% CI 2.77 to 7.91; p<0.001) were protective. Longer poststroke duration (≥5 years) (OR=2.01; 95% CI 1.23 to 3.29; p=0.01) and continuous medication dependence (OR=2.54; 95% CI 1.01 to 6.35; p=0.04) significantly increased odds of severe PSD.

This study reveals an alarmingly high prevalence of severe PSD among older Nigerian adults with chronic poststroke disabilities, driven by demographic, cultural and clinical factors. Integration of routine depression screening and culturally sensitive psychosocial interventions, leveraging social support networks, is imperative to address this substantial mental health burden within stroke rehabilitation programmes in resource-limited settings.