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Ischemic stroke and depression

Published online by Cambridge University Press:  25 February 2003

Desmond David W. ,
Remien Robert H. ,
Moroney Joan T. ,
Stern Yaakov ,
Sano Mary  and
Williams Janet B.W.
Desmond David W.*
Affiliation:
Departments of Neurology and Pathology, SUNY Downstate Medical Center, Brooklyn, New York
Remien Robert H.
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
Moroney Joan T.
Affiliation:
Department of Clinical Neurosciences, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
Stern Yaakov
Affiliation:
Departments of Neurology and Psychiatry and the Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, New York
Sano Mary
Affiliation:
Departments of Neurology and Psychiatry and the Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, New York
Williams Janet B.W.
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
*
Reprint requests to: Dr. David W. Desmond, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 25, Brooklyn, NY 11203. E-mail: dwdesmond@usa.net
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Abstract

Previous studies of depression after stroke have reported widely variable findings, possibly due to differences between studies in patient characteristics and methods for the assessment of depression, small sample sizes, and the failure to examine stroke-free reference groups to determine the base rate of depression in the general population. In an effort to address certain of those methodologic issues and further investigate the frequency and clinical determinants of depression after stroke, we administered the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH–D) and neurological, neuropsychological, and functional assessments to 421 patients (age = 71.5 ± 8.0 years) 3 months after ischemic stroke and 249 stroke-free control subjects (age = 70.8 ± 6.7 years). We required a SIGH–D total score > 11 for the identification of depression. We found that depression was less frequent (47/421 patients, or 11.2%, and 13/249 control subjects, or 5.2%), less severe, and less persistent in our stroke cohort than previously reported, possibly due to the underrepresentation of patients with a premorbid history of affective illness. Depression was associated with more severe stroke, particularly in vascular territories that supply limbic structures; dementia; and female sex. SIGH–D item analyses suggested that a reliance on nonsomatic rather than somatic symptoms would result in the most accurate diagnoses of depression after ischemic stroke. (JINS, 2003, 9, 429–439.)

Keywords

StrokeCerebrovascular diseaseDepressionDementia
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 9 , Issue 3 , 25 March 2003 , pp. 429 - 439
Copyright
Copyright © The International Neuropsychological Society 2003

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