Depression more prevalent among stroke and transient ischemic attack survivors

Study Highlights:

• Depression is common among stroke and transient ischemic attack (TIA) survivors.
• Rates of depression were similar for stroke and TIA.
• The condition often goes unrecognized and under-treated.

Depression is more prevalent among stroke and transient ischemic attack survivors than in the general population, researchers reported in the American Heart Association's journal Stroke.

While most patients with stroke in the study had only mild disability, and only a fraction of those with TIAs had severe disability, depression rates were similar.

"The similar rates of depression following stroke and TIA could be due to similarities in the rates of other medical conditions or to the direct effects of brain injury on the risk of depression, but more studies are needed," said Nada El Husseini, M.D., M.H.S., an author of the study and a Stroke Fellow in the Department of Medicine, Division of Neurology, at Duke University Medical Center in Durham, N.C.

Researchers, analyzing 1,450 adults with ischemic stroke (blockage of a blood vessel in the brain) and 397 with TIA, found:

• Three months after hospitalization, depression affected 17.9 percent of stroke patients and 14.4 percent of TIA patients.
• At 12 months, depression affected 16.4 percent of stroke patients and 12.8 percent of TIA patients.
• Nearly 70 percent of stroke and TIA patients with persistent depression still weren't treated with antidepressant therapy at either the 3 or 12 month intervals.

"Patients need to be open about their symptoms of depression and discuss them with their physicians so that they can work together to improve outcomes," El Husseini said. "It is important for physicians to screen for depression on follow-up after both stroke and TIA."

Researchers defined depression using the Patient Health Questionnaire-8 (PHQ-8), which covers a range of depressive symptoms: loss of interest and pleasure in doing things; feelings of sadness, helplessness and hopelessness; insomnia or oversleeping; lack of energy; feelings of worthlessness; inability to concentrate; loss of appetite or overeating; and moving or speaking slowly. Patients who scored 10 or more on that questionnaire were considered depressed.

Patients with stroke, who had persistent depression, tended to be younger, have greater stroke-related disability and couldn't work at three months follow-up.

"Physicians may need to be more vigilant in screening these patients because of their higher risk for long-term and persistent depression," El Husseini said.

The study participants were in the AVAIL (Adherence eValuation After Ischemic Stroke Longitudinal) Study and patients in hospitals participating in the American Heart Association's Get With The Guidelines™-Stroke in 2006-08.

The median age was 64 for stroke patients and 68 for TIA patients. About 44 percent of the stroke patients and 54 percent of the TIA patients were women. The majority of patients were white.

AVAIL included a geographically national representative group of 106 hospitals.

GWTG-Stroke puts the expertise of the American Stroke Association to work for hospital teams, helping to ensure that the care they provide to stroke patients is aligned with the latest scientific guidelines.

Co-authors are Larry B. Goldstein, M.D.; Eric D. Peterson, M.D., M.H.S.; Xin Zhao, M.H.S.; Wenqin Pan, Ph.D.; Dai Wai M. Olson R.N., Ph.D.; Louise Zimmer, M.A., M.P.H.; John W. Williams Jr., M.D., M.H.S.; Cheryl Bushnell, M.D., M.H.S.; and Daniel T. Laskowitz, M.D. M.H.S. Author disclosures are on the manuscript.

Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provided unrestricted funds for AVAIL, which was conducted through collaboration with the American Heart Association. The Agency for Healthcare Research and Quality cooperative agreement also supported the AVAIL analyses.