The correlates and course of depression in patients with lacunar stroke: Results from the secondary prevention of small subcortical strokes (SPS3) study

Carole L. White, Leslie A. McClure, Patricia M. Wallace, Janet Braimah, Alice Liskay, Ana Roldan, Oscar R. Benavente

    Research output: Contribution to journalArticle

    24 Citations (Scopus)

    Abstract

    Background: Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability. Methods: Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject. Results: The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96-0.99), male gender (OR 0.62; 95% CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3-2.4), living with a spouse/family (OR 1.6; 95% CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06-1.17) for each 1-year increase in time. Conclusions: One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.

    Original languageEnglish (US)
    Pages (from-to)354-360
    Number of pages7
    JournalCerebrovascular Diseases
    Volume32
    Issue number4
    DOIs
    StatePublished - Oct 2011

    Fingerprint

    Lacunar Stroke
    Secondary Prevention
    Stroke
    Depression
    Cerebral Small Vessel Diseases
    Logistic Models
    Spouses

    Keywords

    • Depression after stroke
    • Lacunar stroke
    • Longitudinal study
    • Predictors of outcome
    • Secondary Prevention of Small Subcortical Strokes study

    ASJC Scopus subject areas

    • Clinical Neurology
    • Neurology
    • Cardiology and Cardiovascular Medicine

    Cite this

    The correlates and course of depression in patients with lacunar stroke : Results from the secondary prevention of small subcortical strokes (SPS3) study. / White, Carole L.; McClure, Leslie A.; Wallace, Patricia M.; Braimah, Janet; Liskay, Alice; Roldan, Ana; Benavente, Oscar R.

    In: Cerebrovascular Diseases, Vol. 32, No. 4, 10.2011, p. 354-360.

    Research output: Contribution to journalArticle

    White, Carole L. ; McClure, Leslie A. ; Wallace, Patricia M. ; Braimah, Janet ; Liskay, Alice ; Roldan, Ana ; Benavente, Oscar R. / The correlates and course of depression in patients with lacunar stroke : Results from the secondary prevention of small subcortical strokes (SPS3) study. In: Cerebrovascular Diseases. 2011 ; Vol. 32, No. 4. pp. 354-360.
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    abstract = "Background: Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability. Methods: Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject. Results: The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19{\%}. Older age (OR 0.97; 95{\%} CI 0.96-0.99), male gender (OR 0.62; 95{\%} CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95{\%} CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95{\%} CI 1.3-2.4), living with a spouse/family (OR 1.6; 95{\%} CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95{\%} CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95{\%} CI 1.06-1.17) for each 1-year increase in time. Conclusions: One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.",
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    AU - McClure, Leslie A.

    AU - Wallace, Patricia M.

    AU - Braimah, Janet

    AU - Liskay, Alice

    AU - Roldan, Ana

    AU - Benavente, Oscar R.

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    N2 - Background: Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability. Methods: Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject. Results: The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96-0.99), male gender (OR 0.62; 95% CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3-2.4), living with a spouse/family (OR 1.6; 95% CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06-1.17) for each 1-year increase in time. Conclusions: One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.

    AB - Background: Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability. Methods: Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject. Results: The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96-0.99), male gender (OR 0.62; 95% CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3-2.4), living with a spouse/family (OR 1.6; 95% CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06-1.17) for each 1-year increase in time. Conclusions: One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.

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    KW - Predictors of outcome

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