Early depression screening and short-term functional outcome in hospitalized patients for acute ischemic stroke

Minyoul Baik; Hyungwoo Lee; Il Hyung Lee; JoonNyung Heo; Hyo Suk Nam; Hye Sun Lee; Young Dae Kim

doi:10.3389/fneur.2022.950045

Early depression screening and short-term functional outcome in hospitalized patients for acute ischemic stroke

Front Neurol. 2022 Aug 5:13:950045. doi: 10.3389/fneur.2022.950045. eCollection 2022.

Authors

Minyoul Baik¹, Hyungwoo Lee², Il Hyung Lee², JoonNyung Heo², Hyo Suk Nam^{2

3}, Hye Sun Lee⁴, Young Dae Kim^{2

3}

Affiliations

¹ Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea.
² Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
³ Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, South Korea.
⁴ Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea.

Abstract

Background: Patients with ischemic stroke are at high risk for post-stroke depression (PSD). There are limited data regarding the clinical impact of early PSD, assessed in hospitalized patients with acute ischemic stroke.

Methods: This hospital-based observational cohort study included consecutive patients with acute ischemic stroke or transient ischemic attack between July 2019 and June 2021. In the study hospital, all admitted patients were systematically screened for depression. The depression was screened using the Patient Health Questionnaire-9 (PHQ-9), and PHQ-9 positivity indicated early PSD, which was defined as a score of >4. Logistic regression analyses were used to compare the rates of poor functional outcomes at 3 months in patients with and without PHQ-9 positivity.

Results: Among 1339 patients admitted during the study period, 775 were included, with a median age of 68.0 years, and 316 (40.8%) were women. A total of 111 (14.3%) patients were PHQ-9 positive. History of cancer and early neurological deterioration were independently associated with PHQ-9 positivity. Poor functional outcomes at 3 months were observed in 147 patients (18.8%). PHQ-9 positivity independently showed a 2.2-fold increased risk of poor functional outcome at 3 months (Odds ratio 2.23; 95% confidence interval 1.05-4.73, P = 0.037).

Conclusions: Patients with history of cancer and early neurological deterioration were at risk for early PSD. Early PSD was independently associated with poor functional outcomes at 3 months. The identification of early depression could offer opportunities for further questioning and exploration of symptoms, as well as interventions.

Keywords: Patient Health Questionnaire-9; functional outcome; ischemic stroke; post-stroke depression; transient ischemic attack.