Poststroke Depression Persists or Recurs in Majority of Affected Patients Over 5 Years: Study Finds
UK: A new study published in the Journal of the American Heart Association highlights the long-term burden of depression in stroke survivors and identifies key risk factors that contribute to its persistence and recurrence over five years. The research, led by Lu Liu, MMed, from the School of Life Course and Population Sciences at King’s College London, utilized data from the South London Stroke Register collected between 1997 and 2022.
The study examined 1,724 stroke survivors with a mean age of 65.5 years, of whom 55.9% were men and 65.2% identified as White. Depression was assessed at three months post-stroke and annually for up to five years using the Hospital Anxiety and Depression Scale. Participants with more than two depression assessments were included to evaluate long-term trajectories.
The findings revealed the following:
- 61.9% of patients did not experience depression during the follow-up period.
- 19% of patients had transient depressive symptoms.
- 35.2% experienced recurrent episodes of depression.
- 45.8% suffered from persistent depression.
- Recurrent depression was associated with moderate to severe strokes (adjusted OR 1.81).
- Significant physical disability increased the likelihood of recurrent depression (adjusted OR 1.59).
- Persistent depression was linked to a history of depression before the stroke (adjusted OR 2.67).
- Cognitive impairment after the stroke was associated with persistent depression (adjusted OR 2.09).
- Early physical decline within the first three months post-stroke raised the risk of recurrent or persistent depression, independent of the initial severity of disability.
The study emphasizes the critical need for early screening and long-term monitoring of depression in stroke survivors. According to the authors, recognizing patterns of depression and their underlying risk factors can help tailor treatment strategies. For instance, patients with recurrent depression may benefit significantly from intensive physical rehabilitation, while those with persistent depression might respond better to targeted psychological therapies, particularly when cognitive impairment or a history of depression is present.
The researchers noted several strengths of the study, including its prospective design, large population-based sample, and repeated assessments over an extended follow-up period. However, they acknowledged certain limitations, such as the exclusion of patients with fewer than three assessments, which may have resulted in underrepresentation of individuals with more severe strokes, and the reliance on a screening tool rather than clinician-administered diagnostic interviews for depression.
Overall, the findings highlight the complex interplay between stroke severity, physical disability, cognitive function, and mental health in shaping long-term outcomes for stroke survivors. The study emphasizes the importance of integrated care approaches that address both physical and psychological needs to improve recovery and quality of life.
"Early identification and proactive management of depressive symptoms could play a key role in mitigating long-term disability and enhancing overall prognosis in this vulnerable population," the authors concluded.
Reference:
Liu L, Marshall IJ, Bhalla A, Li X, Ayis S, Wolfe CDA, Wang Y, O'Connell MDL. Long-Term Course of Depression After Stroke and Risk Factors for Symptoms With Poor Progression: A Population-Based Study. J Am Heart Assoc. 2025 Jul 29:e041931. doi: 10.1161/JAHA.125.041931. Epub ahead of print. PMID: 40728181.
