Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies

Simon Ladwig; Katja Werheid; Martin Südmeyer; Matthias Volz

doi:10.3389/fpsyt.2023.1093918

Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies

Front Psychiatry. 2023 Feb 13:14:1093918. doi: 10.3389/fpsyt.2023.1093918. eCollection 2023.

Authors

Simon Ladwig¹, Katja Werheid¹, Martin Südmeyer^{2

3}, Matthias Volz⁴

Affiliations

¹ Clinical Neuropsychology and Psychotherapy, Department of Psychology, Faculty of Psychology and Sport Science, Universität Bielefeld, Bielefeld, Germany.
² Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany.
³ Department of Neurology, Heinrich-Heine-Universität, Düsseldorf, Germany.
⁴ Clinical Psychology I, Department of Psychology, Faculty of Human Sciences, Universität Kassel, Kassel, Germany.

Abstract

Introduction: Cerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke.

Methods: Our study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N ₁ = 273) and one acute care hospital (N ₂ = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n ₁ = 176, n ₂ = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses.

Results: History of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = -0.09 to -0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = -2.69 to -1.91; p < 0.01) outside the acute phase (R ² = 0.15-0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = -0.08/-0.14; p < 0.01), in addition to status scores on established variables (ΔR ² = 0.08, p < 0.001).

Discussion: History of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.

Keywords: depression; dynamic risk factors; multivariable analysis; prospective longitudinal; stroke.

Grants and funding

The authors received funds for open access publication fees from Universität Bielefeld (Department of Psychology, Clinical Neuropsychology and Psychotherapy) and Universität Kassel (Department of Psychology, Clinical Psychology). During the implementation of the Berlin PSD study, MV was supported by the Humboldt University Structured Graduate Programme (Self-Regulation Dynamics Across Adulthood and Old Age). The funding sources had no role in the planning, implementation or writing of this research or manuscript.