Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up

Do facilitators and barriers to community ambulation differ among stroke survivors in low resource settings? A cross-sectional study in Nigeria

PURPOSE

Stroke survivors (SSV) in many low- and middle-income countries experience frustrating participation restriction in community ambulation (CA), which impedes community life. This study assessed facilitators and barriers to CA among community-dwelling SSV in a southwest state of Nigeria.

METHODS

This cross-sectional study involved 66 community-dwelling ambulating SSV, purposively recruited from physiotherapy out-patient clinics of selected hospitals in southwest Nigeria. Semi-structured questionnaire containing physical and social environment elements of the ICF domains was administered on respondents. Mobility status at home and community, socio-demographic and clinical data of SSV were also obtained. Responses from open-ended questions were triangulated with appropriate close ended options. Data were analyzed using descriptive statistics and logistic regression at p < 0.05 Alpha value.

RESULTS

Majority of the SSV were independent in their homes (59.1%), used mobility aids (87.9%) and assisted in CA (66.7%). They identified limited physical accessibility by crowds 25 (37.9%), lack of inclined surfaces 40 (95.2%), uneven floors 36 (87.8%), public seating arrangements 33 (78.6%), rain (73.8%) and inability to use services, systems and policies (77.3%) as barriers to CA. Built physical environment was a significant predictor of home (OR = 0.754, p = 0.001) and community mobility (OR = 0.850; p = 0.018), while post-stroke depression was a significant predictor of community mobility (OR = 1.038; p = 0.014).

CONCLUSION

Mobility aids, social attitudes and general support were identified as facilitators, whereas barriers to CA included built physical environment, services and policies, products and technology. Facilitators and barriers to CA are similar to some HIC contexts, perceived difficulties and experiences differ for infrastructural and social reasons among others.

Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment

BACKGROUND

Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect.

AIM AND METHODS

This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment.

RESULTS

Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions.

CONCLUSIONS

More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.

Malnutrition suppresses improvements in depression symptoms in older adult patients with stroke undergoing convalescent rehabilitation

BACKGROUND & AIMS

Depression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation.

METHODS

This was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated.

RESULTS

The malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (β: -0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (β: -0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms.

CONCLUSION

Malnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.

Association of Sarcopenia and Its Components with Depression Symptoms in Older Patients with Stroke

BACKGROUND

Recent studies have reported an association between sarcopenia and depression symptoms. To date, no reports have investigated the association between sarcopenia and depression symptoms evaluated using the Geriatric Depression Screening Scale (GDS)-15 in patients with stroke. Therefore, this study aimed to investigate the association between sarcopenia and its components and the improvement of depression symptoms in patients with stroke admitted to a convalescent rehabilitation ward.

METHODS

Patients with stroke aged ≥65 years admitted to a convalescent rehabilitation ward were included in the study. Participants were categorized into sarcopenia and non-sarcopenia groups based on the 2019 Asian Working Group for Sarcopenia. Here, depression symptoms were evaluated using the GDS-15, in addition to demographic characteristics. This study's primary outcome was the GDS change from admission to discharge. Multiple regression analysis was performed to investigate the association between GDS change and sarcopenia and its components.

RESULTS

Overall, 118 participants were included, with the mean age of 78.7±8.1 years, and 58 (49%) were classified in the sarcopenia group. Multiple regression analysis showed that sarcopenia (β=-0.283, 95% confidence interval [CI] -1.140 to -0.283, p<0.001) and handgrip strength (β=-0.317, 95% CI -0.162 to -0.014, p=0.021) were independently associated with GDS change.

CONCLUSION

Sarcopenia and handgrip strength were significantly associated with improved depression symptoms in patients with stroke admitted to a convalescent rehabilitation ward. However, further prospective studies should investigate the association between sarcopenia and depression symptoms in patients with stroke.

Effects of motor imagery-based brain-computer interface-controlled electrical stimulation on lower limb function in hemiplegic patients in the acute phase of stroke: a randomized controlled study

Background

Lower limb motor dysfunction is one of the most serious consequences of stroke; however, there is insufficient evidence for optimal rehabilitation strategies. Improving lower limb motor function through effective rehabilitation strategies is a top priority for stroke patients. Neuroplasticity is a key factor in the recovery of motor function. The extent to which neuroplasticity-based rehabilitation therapy using brain-computer interface (BCI) is effective in treating lower limb motor dysfunction in acute ischemic stroke patients has not been extensively investigated.

Objective

This study aimed to assess the impact of BCI rehabilitation on lower limb motor dysfunction in individuals with acute ischemic stroke by evaluating motor function, walking ability, and daily living activities.

Methods

This study was conducted in a randomized controlled trial, involving 64 patients with acute ischemic stroke who experienced lower limb motor dysfunction. All patients were divided into two groups, with 32 patients assigned to the control group was given conventional rehabilitation once a day for 70 min, 5 times a week for 2 weeks, and the experimental group (n = 32) was given BCI rehabilitation on top of the conventional rehabilitation for 1 h a day, 30 min of therapy in the morning and an additional 30 min in the afternoon, for a total of 20 sessions over a two-week period. The primary outcome was lower extremity motor function, which was assessed using the lower extremity portion of the Fugl-Meyer Rating Scale (FMA-LE), and the secondary endpoints were the Functional Ambulation Scale (FAC), and the Modified Barthel index (MBI).

Results

After 20 sessions of treatment, both groups improved in motor function, walking function, and activities of daily living, and the improvements in FMA-LE scores (p < 0.001), FAC (p = 0.031), and MBI (p < 0.001) were more pronounced in the experimental group compared with the control group.

Conclusion

Conventional rehabilitation therapy combined with BCI rehabilitation therapy can improve the lower limb motor function of hemiplegic patients with stroke, enhance the patient's ability to perform activities of daily living, and promote the improvement of walking function, this is an effective rehabilitation policy to promote recovery from lower extremity motor function disorders.

The oxytocin receptor is essential for the protective effect of pair housing on post-stroke depression in mice

The beneficial effect of social interaction in mitigating the incidence of post-stroke depression (PSD) and ameliorating depressive symptoms has been consistently demonstrated through preclinical and clinical studies. However, the underlying relationship with oxytocin requires further investigation. In light of this, the present study aimed to explore the protective effect of pair housing on the development of PSD and the potential relationship with oxytocin receptors. The PSD model was induced by middle cerebral artery occlusion (MCAO) for 50 min, followed by 4-week isolated housing and restrained stress. Subsequently, each mouse in the pair-housing group (PH) was pair-housed with an isosexual healthy partner. Another group was continuously administrated fluoxetine (10 mg/Kg, i.p, once a day) for 3 weeks. To elucidate the potential role of oxytocin, we subjected pair-housed PSD mice to treatment with an oxytocin receptor (OXTR) antagonist (L368,889) (5 mg/Kg, i.p, once a day) for 3 weeks. At 31 to 32 days after MCAO, anxiety- and depressive-like behaviors were assessed using sucrose consumption, forced swim test, and tail-suspension test. The results showed that pair housing significantly improved post-stroke depression to an extent comparable to that of fluoxetine treatment. Furthermore, pair housing significantly decreased corticosterone in serum, increasing OXT mRNA expression in the hypothalamus. Treatment with L368,889 essentially reversed the effect of pair housing, with no discernible sex differences apart from changes in body weight. Pair housing increased hippocampal serotonin (5-HT), but treatment with L368,889 had no significant impact. Additionally, pair housing effectively reduced the number of reactive astrocytes and increased Nissl's body in the cortex and hippocampal CA3 regions. Correspondingly, treatment with L368,889 significantly reversed the changes in the Nissl's body and reactive astrocytes. Moreover, pair housing downregulated mRNA levels of TNF-α, IL-1β, and IL-6 in the cortex caused by PSD, which was also reversed by treatment with L368,889. In conclusion, pair housing protects against the development of PSD depending on OXT and OXTR in the brain, with no significant divergence based on sex. These findings provide valuable insights into the potential of social interaction and oxytocin as therapeutic targets for PSD. Further research into the underlying mechanisms of these effects may contribute to the development of novel treatments for PSD.

Post-Stroke Depression in Older Adults: An Overview

Detailed data on post-stroke depression (PSD) in older adults are limited in spite of the high vulnerability of this population to stroke. In fact, PSD prevalence in older adults ranges from 16.0 to 43.9%; however, timing and instruments of evaluation often differ significantly across all available studies. The etiology, genetic and inflammatory factors, as well as structural brain alterations, are claimed as part of a multifaceted mechanism of action in PSD onset. Thus, the aim of this narrative review was to further elaborate on the prevalence, etiology, diagnosis, consequences and treatment of PSD in older adults. The consequences of PSD in older adults may be devastating, including a poor functional outcome after rehabilitation and lower medication adherence. In addition, lower quality of life and reduced social participation, higher risk of new stroke, rehospitalization, and mortality have been reported. In this scenario, treating PSD represents a crucial step to prevent these complications. Both pharmacological and non-pharmacological therapies are currently available. The pharmacological treatment utilizes antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TAs) and new multimodal antidepressants (NMAs). Non-pharmacological therapies include psychological interventions and non-invasive brain stimulation techniques, while excluding drug administration. In the general population experiencing PSD, SSRIs (sertraline in particular) are the most prescribed, whereas the combination of antidepressants and psychotherapy is underused. Furthermore, about one-third of patients do not receive treatment for PSD. In regard to older adults with PSD, the possibility of more adverse effects or contraindications to antidepressant prescription due to comorbidities may limit the therapeutic window. Although drugs such as citalopram, escitalopram, sertraline, venlafaxine, and vortioxetine are usually well tolerated by older patients with PSD, the few randomized controlled trials (RCTs) specifically considering older adults with PSD have been conducted with fluoxetine, fluvoxamine, reboxetine, citalopram and nortriptyline, often with very small patient samples. Furthermore, data regarding the results of non-pharmacological therapies are scarce. High-quality RCTs recruiting large samples of older adults are needed in order to better manage PSD in this population. In addition, adequate screening and diagnosis instruments, with reliable timing of evaluation, should be applied.

The support dilemma of stroke inpatients and family caregivers under COVID-19 prevention and control: a qualitative study in China

China has implemented a strict isolation system in hospitals since the COVID-19 pandemic, that adversely affected the psychology of inpatients and their caregivers. Face-to-face, semi-structured interviews with 22 stroke inpatients from two municipal hospitals were conducted to explore the psychological, emotional and related support needs of stroke inpatients and their family caregivers under this environment. Results which showed that external support for stroke inpatients and their family caregivers was insufficient highlight the necessity for developing specific nursing interventions that meet the psychological and emotional needs of inpatients and the caregivers.

Association between depression and macrovascular disease: a mini review

Depression and macrovascular diseases are globally recognized as significant disorders that pose a substantial socioeconomic burden because of their associated disability and mortality. In addition, comorbidities between depression and macrovascular diseases have been widely reported in clinical settings. Patients afflicted with coronary artery disease, cerebrovascular disease or peripheral artery disease exhibit an elevated propensity for depressive symptoms. These symptoms, in turn, augment the risk of macrovascular diseases, thereby reflecting a bidirectional relationship. This review examines the physiological and pathological mechanisms behind comorbidity while also examining the intricate connection between depression and macrovascular diseases. The present mechanisms are significantly impacted by atypical activity in the hypothalamic-pituitary-adrenal axis. Elevated levels of cortisol and other hormones may disrupt normal endothelial cell function, resulting in vascular narrowing. At the same time, proinflammatory cytokines like interleukin-1 and C-reactive protein have been shown to disrupt the normal function of neurons and microglia by affecting blood-brain barrier permeability in the brain, exacerbating depressive symptoms. In addition, platelet hyperactivation or aggregation, endothelial dysfunction, and autonomic nervous system dysfunction are important comorbidity mechanisms. Collectively, these mechanisms provide a plausible physiological basis for the interplay between these two diseases. Interdisciplinary collaboration is crucial for future research aiming to reveal the pathogenesis of comorbidity and develop customised prevention and treatment strategies.

Disorders in the gut and liver are involved in depression contagion between isosexual post-stroke depression mice and the healthy cohabitors

Despite the accumulated evidence that pair housing could attenuate post-stroke depression (PSD), but less attention has been paid to the healthy cohabitors, and the underlying mechanisms remain unclear. This study aimed to determine whether there is depressive contagion between PSD mice and their healthy cohabitors. PSD was induced by middle cerebral artery occlusion (MCAO) plus restraint stress for four weeks. Three days after MCAO, the mice were restrained two hours per day and isosexually pair-housed for four weeks. The results showed that, compared with the partners pair housed with normal control mice (Ctrl group), the partners pair housed with PSD mice (CH group) displayed depressive-like behaviors, including decreased sucrose preference rate, significantly shorter duration in the center arena and reduced total distance in the open-field test, and extended immobile time in forced swimming test and tail-suspension test without sex differences. Regarding the change in the body weight, only the males showed a significant reduction on days 17 and 24 after treatment. Furthermore, the CH group showed significantly increased corticosterone and decreased oxytocin (OXT) levels in serum, while the mRNA levels of OXT, vasopressin and oxytocin receptor were remarkably upregulated in the hypothalamus of the CH group. However, there was no significant change in the vasopressin receptor V1a. Interestingly, compared with the Ctrl group, there was a significant decrease in butyrate in serum of the CH group. Consistently, they had mild liver dysfunction with increased alanine transaminase, extended hepatic sinus surrounded by enhanced SLC22A9, and significantly increased Iba1-positive macrophages. Moreover, the expression of tight junction protein (Occludin and ZO-1) obviously decreased in the colon with increasing Iba1-positive cells. These results suggest that isosexual pair-housing with PSD mice causes the healthy partners to develop depressive-like behaviors with disturbances in the gut and liver.

Evaluation of depression status and its influencing factors in convalescent elderly patients with first-episode stroke

OBJECTIVE

To investigate the occurrence and the influencing factors of post-stroke depression (PSD) in first-episode stroke.

METHODS

A total of 350 elderly stroke patients who were admitted to Wuxi Central Rehabilitation Hospital for the first time from January 2020 to December 2020 were enrolled in this study. The Hamilton Depression Scale (HAMD) was used to evaluate the depression status of stroke patients. The sociodemographic data, clinical symptoms, social environment and behavioral patterns of the patients were collected to analyze the related factors of depression after stroke through SPSS 20.0 software.

RESULTS

The incidence of PSD was 45.71%. There were statistical differences among different gender, lesion nature, lesion location, smoking, hypertension, diabetes, hospitalization enpenses, season of onset, BMI index, NIHSS score, barthel index score, blood pressure variation coefficient and other factors (p = 0.000). Post-stroke depression score was positively correlated with NIHSS score and coefficient of variation of systolic blood pressure (r = 0.935, p = 0.000; r = 0.921, p = 0.000), and negatively correlated with barthel index score (r = -0.964, p = 0.000). Through multivariate Logistic regression analysis, it was found that male (OR=8.624, 95%CI: 5.672-11.715), cerebral infarction (OR=2.561, 95%CI: 1.256-3.567), and the right side lesion (OR=1.933, 95%CI: 1.024-3.026), smoking (OR=2.457, 95%CI: 1.611-3.625), onset in autumn and winter (OR=2.049, 95%CI: 1.201-2.919), high BMI (OR=2.461, 95%CI): 1.426-3.432) were risk factors for depression after stroke, and low SBPV (OR=0.567, 95%CI: 0.352-0.758) and low NISHH score (OR=0.256, 95%CI: 0.105-0.486) were the protective factor for subsequent depression of stroke.

CONCLUSION

Males, smoking, patients with onset in autumn and winter, lesions on the right side, high BMI, high NISHH score and high systolic blood pressure variation were closely related to PSD, which should be paid for attention for such patients to prevent the occurrence of PSD and take intervention measures.

Repeated Measures of Modified Rankin Scale Scores to Assess Functional Recovery From Stroke: AFFINITY Study Findings

Background

Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial.

Methods and Results

Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke <70 years; no prestroke history of diabetes, coronary heart disease, or ischemic stroke; prestroke history of depression, a relationship partner, living with others, independence, or paid employment; no fluoxetine intervention; ischemic stroke (compared with hemorrhagic); stroke treatment in Vietnam (compared with Australia or New Zealand); longer time since current stroke; and lower baseline National Institutes of Health Stroke Scale & Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model.

Conclusions

Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value.

Registration

URL: http://www.anzctr.org.au; Unique identifier: ACTRN12611000774921.

Evaluation and Treatment of Depression in Stroke Patients: A Systematic Review

Those who received early diagnosis and treatment for poststroke depression had lower mortality rates, cognitive impairments, improved long-term disability, a higher quality of life, and lower rates of suicidal thoughts than those who did not. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were used to conduct this systematic review. Until May 1, 2022, a systematic search was conducted utilizing ScienceDirect, Cochrane, PubMed, Google Scholar, and PubMed central databases, which have been used during the previous 10 years. Randomized controlled trials (RCTs), observational studies, systematic reviews, review articles, case reports, clinical studies, and meta-analyses were included in the research, which covered post-stroke depression patients and how to identify and treat them. There were 545 possibly related titles found in the database search. Finally, each publication was given a quality rating, and 10 studies with a score of higher than 70% were allowed into the review. Because of their brevity and ease of use, they employed the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 screening instruments in stroke patients. According to pooled studies, the risk of acquiring post-stroke depression (PSD) was lower in participants undergoing pharmacological therapy with selective serotonin reuptake inhibitors (SSRIs), especially after a year. Identifying further features of the PSD process, we believe, is the most pressing need for future study since it might lead to a more precise treatment strategy.

Measures Associated With Early, Late, and Persistent Clinically Significant Symptoms of Depression 1 Year After Stroke in the AFFINITY Trial

OBJECTIVE

To determine the sociodemographic and clinical factors associated with early, late and persistent clinically significant symptoms of depression during the first year after a stroke.

METHODS

Cohort study of 1221 men and women recruited within two weeks of stroke onset in Australia, New Zealand and Vietnam. The NIH Stroke Scale (NIHSS) was used to assess the severity of the stroke. Other study measures included age, sex, marital status, living arrangements, function before the stroke, depression before the stroke, modified Rankin Scale (mRS), and treatment with fluoxetine or placebo for 26 weeks. Clinically significant symptoms of depression during the 52 weeks after baseline was the outcome of interest, and its presence was defined by a total PHQ-9 score of 9 or higher at weeks 4, 12, 26 or 52, a clinician diagnosis of depression between assessments, or by pharmacological or psychological treatment of depression during follow up. Participants were classified as not depressed, or as early (initial 12 weeks), late (12 to 52 weeks) or persistent depression (before and after 12 weeks). We used multinomial logistic regression to assess depression risk, with all listed measures entered simultaneously into the model.

RESULTS

The mean age of participants was 63.8 (SD=12.3) years and 775 (63.5%) were male. At baseline, 48 (3.9%) participants had previous treated depression, and 228 (18.7%) had clinically significant symptoms of depression (PHQ-9 ≥ 9). 734 (63.3%) participants showed no evidence of depression in the year following the stroke, 208 (17.9%) had early, 86 (7.4%) late, and 131 (11.3%) persistent depression. Increased stroke severity, as measured by doubling of NIHSS scores, was associated with an increased risk of early (Risk Ratio [RR]=2.08, 95%CI=1.65-2.62), late (RR=1.53, 95%CI=1.14-2.06) and persistent clinically significant symptoms of depression (RR=2.50, 95%CI=1.89-3.32). Similar findings were apparent for the mRS, a measure of functional disability. Past depression was associated with increased risk of persistent clinically significant symptoms of depression (RR=6.28, 95%CI=2.88-13.71), as was being married or partnered (RR=3.94, 95%CI=2.42-6.41). The risk of clinically significant symptoms of depression was higher in Australia and New Zealand than in Vietnam.

CONCLUSION

The severity of neurological and functional deficits increases the risk of post-stroke clinically significant symptoms of depression early and persistently. Depression before stroke, personal relationships and cultural context contribute to mediate depression risk. Interventions that minimise the severity of neurological and functional deficits should decrease the risk of post-stroke clinically significant symptoms of depression.

Role of social support in poststroke depression: A meta-analysis

Poststroke depression significantly affects health and quality of life of stroke patients. This study evaluates the role of social support in influencing poststroke depression. The literature search was conducted in electronic databases and study selection was based on precise eligibility criteria. The prevalence rates reported by individual studies were pooled. A meta-analysis of standardized mean differences (SMD) in social support between depressed and non-depressed stroke patients was performed. The odds ratios and correlation coefficients showing the relationship between social support and depression were pooled to achieve overall estimates. Twenty-five studies (9431 patients) were included. The prevalence of depression was 36% [95% confidence interval (CI): 28, 45]. Patients with poststroke depression had significantly lower social support in comparison with patients with no or lower levels of depression [SMD in social support scores -0.338 (95% CI: -0.589, -0.087); p = 0.008]. The odds of depression were lower in patients receiving higher levels of social support [OR 0.82 (95% CI: 0.69, 0.95)] but were higher in patients who were receiving weaker social support [OR 5.22 (95% CI: -0.87, 11.31)]. A meta-analysis of correlation coefficients found a significantly inverse correlation between social support and poststroke depression [r -0.336 (95% CI: -0.414, -0.254)]. Poststroke depression has a significant independent inverse association with social support.

The etiologies of post-stroke depression: Different between lacunar stroke and non-lacunar stroke

OBJECTIVES

Depression is common after both lacunar stroke and non-lacunar stroke and might be associated with lesion locations as proven by some studies. This study aimed to identify whether lesion location was critical for depression after both lacunar and non-lacunar strokes.

METHODS

A cohort of ischemic stroke patients was assigned to either a lacunar stroke group or a non-lacunar stroke group after a brain MRI scan. Neurological deficits and treatment response was evaluated during hospitalization. The occurrence of depression was evaluated 3 months later. Logistic regressions were used to identify the independent risk factors for depression after lacunar and non-lacunar stroke respectively.

RESULTS

83 of 246 patients with lacunar stroke and 71 of 185 patients with non-lacunar stroke developed depression. Infarctions in the frontal cortex, severe neurological deficits, and a high degree of handicap were identified as the independent risk factors for depression after non-lacunar stroke, while lesion location was not associated with depression after lacunar stroke.

CONCLUSION

The main determinants for depression after lacunar and non-lacunar stroke were different. Lesion location was critical only for depression after non-lacunar stroke.

Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence

Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.

Disability Status and Its Influencing Factors Among Stroke Patients in Northeast China: A 3-Year Follow-Up Study

PURPOSE

To explore the rate of post-stroke disability and its associated factors in the third year following discharge from inpatient rehabilitation in Northeast China.

DESIGN

A prospective cohort study.

METHODS

A total of 522 persons who were hospitalized with a diagnosis of stroke were recruited consecutively between April 2015 and December 2015 and followed for 3 years. The primary outcome was disability, which was assessed using the Modified Barthel Index (MBI), a cutoff score of ≤95 indicates disability. Plausible risk factors of disability were selected from available variables to perform multivariate logistic regression analysis.

FINDINGS

The proportion of post-stroke patients with disability decreased from 63.8% to 46.7% at 3-year follow-up. The factors associated with post-stroke disability were age, neurological deficits, cognitive function, depression, and social support.

CONCLUSIONS/CLINICAL RELEVANCE

Disability continues to be a significant issue for individuals after a stroke, and community health workers should perform targeted assessments and interventions to decrease disability, and pay special attention to individuals who are at greatest risk of post-stroke disability.

Influence of Physical Activity and Socio-Economic Status on Depression and Anxiety Symptoms in Patients after Stroke

Stroke is a high-risk factor for depression. Neurological rehabilitation is greatly difficult and often does not include treatment of depression. The post-stroke depression plays an important role in the progress of treatment, health, and the life of the patient. The appropriate treatment of depression could improve the quality of life of the patient and their family. The study aimed to evaluate the impact of physical activity and socio-economic status of the patient on the effectiveness of recovery from depression and the severity of the symptoms of depression. The study was conducted with 40 patients after stroke aged 42–82 years, and included 10 women and 30 men who were hospitalized for two weeks. The severity of depression/anxiety (D/A) symptoms were evaluated two times; at admission and after two weeks of physical therapy. The hospital anxiety and depression scale (HADS) questionnaire was used for this purpose. Socio-economic status was evaluated by several simple questions. It was revealed that physical therapy has a positive influence on mental state. The severity of D/A symptoms after stroke is related to the financial status of the patients (χ² = 11.198, p = 0.024). The state of health (χ² = 20.57, p = 0.022) and physical fitness (χ² = 12.95, p = 0.044) changed the severity of symptoms of anxiety and depressive disorders. The kinesiotherapy in the group of patients with post-stroke depression had positive effects; however, economic and health conditions may influence the prognosis of the disease.

Reminiscence therapy serves as an optional nursing care strategy in attenuating cognitive impairment, anxiety, and depression in acute ischemic stroke patients

BACKGROUND

Reminiscence therapy is revealed to improve cognitive function and attenuate psychological disorders in neurological diseases such as Alzheimer's disease patients, while its application in acute ischemic stroke (AIS) is seldom reported. So, the current study aimed to explore the effect of reminiscence therapy on cognitive impairment, anxiety, depression, and disease recurrence in AIS patients.

METHODS

A total of 216 first-ever AIS patients were enrolled and randomized into reminiscence therapy group or control group in 1:1 ratio. MMSE, HADS, and Zung SAS/SDS scales were evaluated at the discharge from hospital (M0), 3 months (M3), 6 months (M6), 9 months (M9), and 12 months (M12), respectively. Besides, patients were further followed up to 36 months for recurrence-free survival (RFS) calculation.

RESULTS

Reminiscence therapy group showed higher MMSE score at M9 and M12, lower cognitive impairment rate by MMSE at M12 compared to control group. As to anxiety, HADS-anxiety score and anxiety rate by HADS were of no difference at each time point, while SAS score and anxiety rate by SAS were lower at M12 in reminiscence therapy group compared with control group. Regarding depression, HADS-depression score and depression rate by HADS at M12, SDS score at M9 and M12, and depression rate by SDS at M12 were all lower in reminiscence therapy group compared with control group. In terms of RFS, it was similar between reminiscence therapy group and control group.

CONCLUSION

Reminiscence therapy cripples cognitive impairment, anxiety, and depression, but does not affect RFS in AIS patients, indicating its potential for post-stroke management.

Anxiety and Depression in Patients With Physical Diseases and Associated Factors: A Large-Scale Field Survey in General Hospitals in China

Introduction: To investigate the characteristic of anxiety and depression among patients in general hospitals, and explore the degree of the clinical symptoms and correlated social economic factors. Methods: This is a cross-sectional survey of anxiety and depression in patients with physical diseases, who were suspected of depression and anxiety based on their clinical performance by their physicians and PHQ ≧ 8, from various clinical departments of 57 general hospitals in China. Data regarding demographic characteristics and clinical characteristics were collected. Social and psychological factors and the severity of anxiety or depression were collected through self-rating scales. Finally, we used multivariate logistic regression to identify the factors associated with anxiety and depression in patients with physical diseases. Results: A total of 2,105 (84.6%) valid and completed questionnaires were returned. The proportion of anxiety, depression, combined depression and anxiety, either anxiety or depression among the patients with physical diseases from all clinical departments was 63.3, 75.1, 57.1, and 81.2% respectively. Further regression analysis indicated that gender, monthly income, specific physical diseases, personality traits, social supports and life negative events were related factors of both anxiety and depression. Conclusions: Anxiety and depression were common in patients with physical diseases, with a high proportion of co-morbidity of anxiety and depression. Females, patients with cancer, poor social support and negative life events reported more severe anxiety and depression. The results may help to understand the present situation of anxiety and depression in general hospitals in china, and identify the patients with high risk of depression and anxiety.