Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage

Radhika Avadhani; Richard E Thompson; Lourdes Carhuapoma; Gayane Yenokyan; Nichol McBee; Karen Lane; Noeleen Ostapkovich; Agnieszka Stadnik; Issam A Awad; Daniel F Hanley; Wendy C Ziai

doi:10.1016/j.jstrokecerebrovasdis.2021.106082

Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2021 Nov;30(11):106082. doi: 10.1016/j.jstrokecerebrovasdis.2021.106082. Epub 2021 Sep 10.

Affiliations

¹ Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
⁴ Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
⁵ Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: weziai@jhmi.edu.

PMID: 34517296
PMCID: PMC8532502
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106082

Abstract

Objectives: To determine factors associated with post-stroke depression (PSD) and relationship between PSD and functional outcomes in spontaneous intracerebral hemorrhage (ICH) using prospective data from a large clinical trial.

Materials and methods: MISTIE III, a randomized, multicenter, placebo-controlled trial, was conducted to determine if minimally invasive surgery with thrombolysis improves outcome compared to standard medical care. Our primary outcome was post-stroke depression at 180 days. Secondary outcomes were change in blinded assessment of modified Rankin Scale (mRS) from 30 to 180 days, and from 180 to 365 days. Logistic regression models were used to assess the relationship between PSD and outcomes.

Results: Among 379 survivors at day 180, 308 completed Center for Epidemiologic Studies Depression Scale, of which 111 (36%) were depressed. In the multivariable analysis, female sex (Adjusted Odds Ratio [AOR], 95% Confidence Interval [CI]: 1.93 [1.07-3.48]), Hispanic ethnicity (3.05 [1.19-7.85]), intraventricular hemorrhage (1.88 [1.02-3.45]), right-sided lesions (3.00 [1.43-6.29]), impaired mini mental state examination at day 30 (2.50 [1.13-5.54]), and not being at home at day 30 (3.17 [1.05-9.57]) were significantly associated with higher odds of PSD. Patients with PSD were significantly more likely to have unchanged or worsening mRS from day 30 to 180 (42.3% vs. 25.9%; p=0.004), but not from day 180 to 365.

Conclusions: We report high burden of PSD in patients with large volume ICH. Impaired cognition and not living at home may be more important than physical limitations in predicting PSD. Increased screening of high-risk post-stroke patients for depression, especially females and Hispanics may be warranted.

Keywords: Clinical outcomes; Cognitive impairment; Intracerebral hemorrhage; Post-stroke depression.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Cerebral Hemorrhage* / epidemiology
Cerebral Hemorrhage* / therapy
Depression* / epidemiology
Female
Humans
Prospective Studies
Risk Factors
Stroke* / complications
Survivors* / psychology

Grants and funding

U01 NS080824/NS/NINDS NIH HHS/United States