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Shewangizaw S, Fekadu W, Gebregzihabhier Y, Mihretu A, Sackley C, Alem A. Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis. PLoS One 2023; 18:e0294668. [PMID: 38039323 PMCID: PMC10691726 DOI: 10.1371/journal.pone.0294668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. METHODS Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. RESULTS Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). CONCLUSION Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).
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Affiliation(s)
- Seble Shewangizaw
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubalem Fekadu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Gebregzihabhier
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Awoke Mihretu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Atalay Alem
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Muacevic A, Adler JR, Gutlapalli SD, Prakash K, Swarnakari KM, Bai M, Manoharan MP, Raja R, Desai A, Desai DM, Arcia Franchini AP. Poststroke Depression, An Underrated Clinical Dilemma: 2022. Cureus 2022; 14:e32948. [PMID: 36712776 PMCID: PMC9879592 DOI: 10.7759/cureus.32948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
It is known that the majority of patients are prone to develop depression following a stroke. Several biological factors, including the disruption of the hypothalamic and adrenal axis and changes in cortisol and interleukin 6 (IL6), are said to have an essential role in its development. Magnetic resonance imaging (MRI) scans point toward white matter lesions and lacunar infarcts as the primary pathological culprit. People affected by poststroke depression (PSD) are more likely to commit suicide or develop another ischemic event after the initial episode, which can likely increase the mortality related to PSD and stroke. Selective serotonin reuptake inhibitors (SSRIs) are the mainstay of treatment for PSD. However, it has a poor safety profile and is not very productive, making the use of SSRIs controversial, and further studies are required to prove its benefits concerning PSD. This literature review discusses the importance of PSD, how it impacts the quality of life of people affected by stroke, and its treatment.
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Lu Y, Li CJ, Li WJ, Zhou M, Liu L. Depressive-like behaviors induced by chronic cerebral hypoperfusion associate with a dynamic change of GABA B1/B2 receptors expression in hippocampal CA1 region. Physiol Behav 2022;:113887. [PMID: 35724927 DOI: 10.1016/j.physbeh.2022.113887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/07/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022]
Abstract
Cerebral ischemia could induce depressive-like behaviors; however, the alteration of gamma-aminobutyric acid receptors type B (GABAB) receptors in these pathological processes has not been extensively investigated. The aim of the current study was to document the behavioral change and the alteration of GABAB receptors in chronic cerebral hypoperfusion. The permanent occlusion of the bilateral common carotid arteries (two-vessel occlusion, 2VO) was performed to induce chronic cerebral ischemia (CCH). The depressive-like behaviors were evaluated with sucrose preference test, novelty suppress feeding test as well as forced swim test at 4, 8, and 12 weeks after the 2VO surgery. The total, surface and intracellular expressions of GABAB subunit 1 (GABAB1) and subunit 2 (GABAB2) in hippocampal CA1 were quantified by western blot. The depressive-like behaviors were observed in rats suffered from 4, 8, and 12 weeks 2VO in sucrose preference test, novelty suppress feeding test and forced swim test. In addition, the surface and total expression of GABAB1 in CA1 was reduced at 4 weeks after 2VO rather than 8 or 12 weeks. While the surface and total expression of GABAB2 in CA1 was decreased throughout the ischemia timeline (4, 8, and 12 weeks). Taken together, our findings suggested the potential roles of GABAB1 and GABAB2 subunits involved in depressive-like behaviors caused by chronic cerebral hypoperfusion.
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Abstract
BACKGROUND Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. METHODS We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. RESULTS A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. CONCLUSION PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).
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Affiliation(s)
- Shuangmei Zhang
- Department of Rehabilitation, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Anrong Wang
- Science and Technology Innovation Center Affiliated To Guangzhou, University of Traditional Chinese Medicine, Guangzhou, 510145, China
| | - Weifeng Zhu
- Department of Neurology, Affiliated Chinese Medicine Hospital of Guangzhou Medical University, Guangzhou, 510145, China
| | - Zhaoyang Qiu
- Department of Neurology, First College of Clinical Medicine Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Zhaoxu Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, 100044, China.
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Abstract
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.
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Affiliation(s)
| | - Andrew Ford
- University of Western Australia, Australia (A.F., O.P.A.)
| | | | | | - Gillian E Mead
- University of Edinburgh, United Kingdom (H.-Y.Y.C., G.E.M.)
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Lee EH, Kim JW, Kang HJ, Kim SW, Shin IS, Kim JT, Park MS, Cho KH, Kim JM. Effects of acute and chronic depression on 12-year long-term outcomes after stroke. Int J Geriatr Psychiatry 2021; 36:1759-1766. [PMID: 34227701 DOI: 10.1002/gps.5597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aimed to investigate whether acute and chronic poststroke depression (PSD) were associated with cardio-cerebrovascular events (CVEs). METHODS A total of 423 patients with recent stroke were recruited from 2006 to 2009. They were diagnosed with major or minor depressive disorder during the acute phase (within 2 weeks) after stroke. Of these, 284 completed the same diagnostic evaluation during the chronic phase (1 year) after stroke. An average 12-year (range 8.7-14.1 years) follow-up was conducted to assess composite CVEs including recurrent stroke, myocardial infarction, and vascular death after the index stroke. During the follow-up, Kaplan-Meier event rates for outcomes were calculated, and hazard ratios were estimated using Cox regression models after adjusting for a range of covariates. RESULTS The composite CVE incidence was higher in patients with acute or chronic PSD than in those without. Composite event incidence was highest in patients with PSD during both the acute and chronic phases. CONCLUSIONS The presence of depression at acute and chronic phase of stroke predicted worse long-term cardio-cerebrovascular outcomes. Evaluation of PSD during both the acute and chronic phases is recommended.
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Affiliation(s)
- Eun-Hye Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Abstract
BACKGROUND AND PURPOSE Poor mental health and depression are well-recognized sequelae of stroke; however, the association between stroke and subsequent risk of suicide is unknown. METHODS We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to September 15, 2020, using keywords and database-specific subjects. We independently adjudicated and selected observational studies that reported suicide attempts or death by suicide in stroke survivors and a comparison group, consisting either of people without a history of stroke or the general population. We evaluated study quality using the Newcastle Ottawa scale. Using random-effects meta-analysis, we calculated the pooled adjusted risk ratio (RR) of suicide in stroke survivors and separately calculated the pooled adjusted RR of suicide attempt and death by suicide. Using prespecified analyses, we explored study-level factors to explain heterogeneity. RESULTS We screened 4093 articles and included 23 studies of fair quality, totaling over 2 million stroke survivors, of whom 5563 attempted suicide or died by suicide. Compared to the nonstroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% CI, 1.53-1.96, I2=93%), with a significantly (P=0.03) higher adjusted risk of suicide attempt (RR, 2.11 [1.73-2.56]) than of death by suicide (RR, 1.61 [1.41-1.84]). A longer follow-up time in cohort studies was associated with a lower risk of suicide (RR, 0.97 [0.95-0.99] for every 1-year increase). CONCLUSIONS Stroke should be considered as a risk factor for suicide. Comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in stroke survivors.
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Affiliation(s)
- Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Canada (M.V.V., J.Z.W., M.M.G.)
| | - Jeffrey Z Wang
- Division of Neurology, Department of Medicine, University of Toronto, Canada (M.V.V., J.Z.W., M.M.G.)
| | - Meah M Gao
- Division of Neurology, Department of Medicine, University of Toronto, Canada (M.V.V., J.Z.W., M.M.G.)
| | - Daniel G Hackam
- Division of Clinical Pharmacology, Department of Medicine, Western University, Canada (D.G.H.)
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Abstract
Background: The prevalence of suicidal ideation (SI) among stroke survivors has been the subject of several studies, but systematic review data regarding the prevalence of SI among stroke patients are still scarce.Objectives: To estimate the pooled prevalence of SI among stroke survivors.Methods: A comprehensive search strategy was established across the following electronic databases; Web of Science, PubMed, the Cochrane Library, Chinese Wanfang database and Chinese National Knowledge Infrastructure (CNKI). The 95% confidence interval (CI) given in each identified study was used to assess the outcomes. Cochran's Q test and I2 statistic were used to evaluate heterogeneity. The quality of the final evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We calculated the pooled prevalence of SI among stroke survivors before subgroup analysis and meta-regression was used to find the partial source of heterogeneity.Results: Twenty-one studies with a total of 17,189 participants were included in this study and the pooled prevalence of SI among stroke survivors was 12.25% (95%CI: 9.91-15.07%). Substantial heterogeneity was detected in the estimation of prevalence. The evidence was graded as very low for the overall outcome and the single item subgroup, while it was graded as low for the stable scale subgroup.Conclusions: This meta-analysis suggests a high prevalence of SI among stroke survivors. Routine screening of SI after stroke is needed to plan interventions aimed at reducing suicide risk.
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Affiliation(s)
- Xingxing Chen
- International Nursing College, Hainan Medical University, Haikou, Hainan, China
| | - Hua Zhang
- International Nursing College, Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
| | - Gui Xiao
- International Nursing College, Hainan Medical University, Haikou, Hainan, China
| | - Chuanzhu Lv
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China.,Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
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Conroy SK, Brownlowe KB, McAllister TW. Depression Comorbid With Stroke, Traumatic Brain Injury, Parkinson's Disease, and Multiple Sclerosis: Diagnosis and Treatment. Focus (Am Psychiatr Publ) 2020; 18:150-161. [PMID: 33162852 DOI: 10.1176/appi.focus.20200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.
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Affiliation(s)
- Susan K Conroy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Katherine B Brownlowe
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
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Choi JW, Lee SG, Kim TH, Han E. Poststroke suicide risk among older adults in South Korea: A retrospective longitudinal cohort study. Int J Geriatr Psychiatry 2020; 35:282-289. [PMID: 31859411 DOI: 10.1002/gps.5245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The present study evaluated suicide risk within 1 year after discharge among older adults with stroke as a function of depression onset. METHOD We used the Korean National Health Insurance Service-Senior cohort data and included first discharged patients with a stroke as the principal diagnosis. The comparison group was selected by a 1:2 case-control propensity score matching for age, sex, Charlson comorbidity index, and diagnosis year between 2005 and 2012. Suicide deaths were measured by code for causes of death from Statistics Korea, and the main outcome was suicide death within 1 year following discharge. An adjusted hazard ratio (AHR) of suicidal risk was measured using a Cox proportional hazard model. RESULTS In the total sample of 128 286 older adults (aged 63-114 years), the higher suicidal risk was examined for stroke patients vs the comparison group (AHR = 1.4; 95% confidence interval [CI], 1.1-1.8). Stroke patients with depression had an increased suicide risk (AHR = 2.9; 95% CI, 1.8-4.8) but only for poststroke depression (AHR = 4.1; 95% CI, 1.8-9.5). Pre and poststroke depression suicidality (AHR = 4.8; 95% CI, 2.1-11.1) was also higher when compared to stroke patients without depression. CONCLUSIONS Poststroke patients are at increased suicidal risk during 1 year following discharge. Furthermore, patients who were diagnosed with depression after a stroke are more likely to commit suicide than stroke patients without depression. This suggests a necessity for early suicide preventive intervention for stroke patients while considering depressive symptomology.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Sang Gyu Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
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Cai W, Mueller C, Li YJ, Shen WD, Stewart R. Post stroke depression and risk of stroke recurrence and mortality: A systematic review and meta-analysis. Ageing Res Rev 2019; 50:102-109. [PMID: 30711712 DOI: 10.1016/j.arr.2019.01.013] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post stroke depression is a significant neuropsychiatric manifestation, predicting a range of poor outcomes. There are several studies investigating the association between post stroke depression and stroke recurrence/mortality, but results have been inconsistent. OBJECTIVE A systematic review, meta-analysis and meta regression of observational studies assessing the association between post stroke depression and risk of stroke recurrence and mortality. METHODS A search of Medline (via PubMed), Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews was conducted until August 2018. We extracted and pooled hazard ratios from observational studies that reported the risk estimates of stroke recurrence and mortality in stroke survivors with/without depression. RESULTS The reviewed sample comprised 15 prospective cohort studies with 250,294 participants, 139,276 cases, and follow-up periods ranging from 1 to 15 years. The meta-analysis concluded a hazard ratio for post stroke depression and all-cause mortality of 1.59 (95% CI, 1.30-1.96), but research to date has been insufficient to determine the association between post stroke depression and stroke recurrence. CONCLUSION AND RELEVANCE Post stroke depression is associated with a significantly increased risk of mortality in stroke survivors. More researches are required on the association with stroke recurrence.
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Cai W, Stewart R, Mueller C, Li YJ, Shen WD. Poststroke depression and risk of stroke recurrence and mortality: protocol of a meta-analysis and systematic review. BMJ Open 2018; 8:e026316. [PMID: 30559164 PMCID: PMC6303620 DOI: 10.1136/bmjopen-2018-026316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A number of observational studies have indicated that poststroke depression could increase the risk of stroke outcomes. There is a meta-analysis indicating that poststroke depression is a risk factor of all-cause mortality. This paper reports the protocol for a systematic review and meta-analysis to clarify the associations of poststroke depression with stroke recurrence and mortality in order to determine whether poststroke depression is a predictor of stroke outcomes according to data extracted from relevant observational studies. METHODS AND ANALYSIS MEDLINE, Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews will be used to conduct the search. Published studies written in English will be included. The risk of bias for the studies included in the systematic review or meta-analysis will be assessed by the Newcastle-Ottawa Quality Assessment Scale. HRs for stroke recurrence and mortality with 95% CIs will be included as primary outcomes. Subgroup analyses and meta-regression will be performed. ETHICS AND DISSEMINATION Ethics approval will not be needed because the data used in this systematic review will be extracted from published studies. The results of the systematic review focusing on whether depression after stroke is a predictor for stroke recurrence and mortality will be disseminated by publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018107944.
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Affiliation(s)
- Wa Cai
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Robert Stewart
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christoph Mueller
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Yi-Jing Li
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei-Dong Shen
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Wu VCC, Chang SH, Kuo CF, Liu JR, Chen SW, Yeh YH, Luo SF, See LC. Suicide death rates in patients with cardiovascular diseases - A 15-year nationwide cohort study in Taiwan. J Affect Disord 2018; 238:187-193. [PMID: 29885608 DOI: 10.1016/j.jad.2018.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/22/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The literature on suicide mortality rates in patients with cardiovascular diseases (CVDs) is limited. METHODS Taiwan National Health Insurance Research Database and Taiwan Death Registry were retrieved for patients with the 5 CVDs: congestive heart failure (CHF), acute myocardial infarction (AMI), ischemic stroke (IS), hemorrhagic stroke (HS), and pacemaker implantation (PMI) between January 1, 2001, and December 31, 2015. We excluded patients younger than 15 years old. The primary outcome was suicidal death. The standardized mortality ratio (SMR) was used to compare the risk of suicidal death in the 5 CVDs to the general population. RESULTS From 2001 to 2015, there were 212,206 patients with CHF, 178,894 patients with AMI, 475,359 patients with IS, 189,555 patients with HS, and 64,173 patients with PMI. The suicide death rate per 100,000 person-year, 95% CI was 59.6 (54.5-64.8) for those with CHF, 44.6 (40.1-49.1) for AMI, 57.6 (54.7-60.5) for IS, 44.6 (40.2-49.0) for HS, 54.0 (45.9-62.0) for PMI, and 20.3 (20.1-20.4) for the general population. Patients with CHF patients had the highest SMR (2.10), followed by IS (1.96), PMI (1.86), HS (1.65), and AMI (1.46). The SMRs for patients with CVDs peaked at year 2 after the diagnosis, declined for patients with AMI, IS, and HS, increased and decreased for PMI alternately, and reached very similar values all five CVDs after 10th year after the diagnosis. CONCLUSIONS Patients with acute CVD with AMI, IS, and HS had suicide death rates peaked early after diagnosis, but patients with chronic CVD with CHF and PMI had suicide death rates that increased progressively. In addition, patients with PMI, CHF, IS had highest association with psychiatric illness and patients with PMI who were of young to middle age had highest suicide death rate.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yung-Hsin Yeh
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shue-Fen Luo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
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