Persistent Depression is a Predictor of Quality of Life in Stroke Survivors: Results from a 5-Year Follow-Up Study of a Chinese Cohort
Stroke remains a leading health problem worldwide, despite significant advancements in therapeutic interventions that have reduced fatality rates during the acute phase. However, the long-term quality of life (QoL) of stroke survivors has become an increasingly important area of research. Various factors, including age, sex, comorbidities, stroke severity, anxiety, and depression, have been identified as determinants of QoL in chronic stroke patients. Among these, depression has been highlighted as a major independent variable affecting QoL. While cross-sectional studies have shown a correlation between depression and low QoL at various stages post-stroke, longitudinal studies investigating the impact of depression on QoL are rare. This study aimed to determine whether persistent depression at one year after stroke could predict QoL at five years post-stroke.
Introduction
Stroke is a significant global health issue, and maintaining or improving the QoL of stroke survivors in the chronic stage is crucial. Depression, particularly post-stroke depression (PSD), is a well-documented sequel of stroke. Some studies suggest that PSD exacerbates the severity of other stroke-induced disabilities. However, the time course of PSD and its impact on long-term QoL remain unclear. This study sought to address this gap by examining whether persistent depression at one year post-stroke could predict QoL at five years post-stroke.
Methods
This study analyzed data from the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China (PRIOD), which involved 56 hospitals across China. Patients were recruited between April 2008 and April 2010 and were followed up in person at 2 weeks, 3 months, 6 months, and 1 year post-stroke. A telephone follow-up was conducted at five years post-stroke. The study included patients over 18 years old with a confirmed stroke diagnosis via computed tomography or magnetic resonance imaging within 14 days. Exclusion criteria included dementia, severe aphasia, other neurological diseases affecting cognitive function, psychiatric diagnoses, communication difficulties, or death within the five-year follow-up period.
Demographic and clinical data, including age, sex, living conditions, education, marital status, medical history, vascular risk factors, and stroke type, were collected at enrollment. At the five-year follow-up, data on stroke recurrence, disability, depression, QoL, and chronic complications were collected. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and QoL was measured using the Short Form-12 (SF-12). The SF-12 includes eight domains grouped into two summary measures: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Disability was assessed using the modified Rankin Scale (mRS), with a score of ≥2 indicating disability.
Results
Of the 801 patients included in the final analysis, 80 had persistent depression at the one-year follow-up. Multivariable ordinal logistic regression analysis revealed that persistent depression at one year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29–0.81) and disability at five years (OR: 0.34; 95% CI: 0.23–0.49) were independently associated with poor MCS scores at five years. Additionally, old age, high National Institutes of Health Stroke Scale (NIHSS) scores at admission, disability at five years, and stroke recurrence within five years were associated with poor PCS scores at the five-year follow-up.
Patients with persistent depression were significantly older, more likely to be female, had higher NIHSS scores at admission, and were less likely to have had an ischemic stroke compared to those without depression. At the five-year follow-up, patients with persistent depression had significantly higher disability rates and lower PCS and MCS scores than those without depression.
Discussion
This study highlights the significant impact of persistent depression on the QoL of stroke survivors. Persistent depression at one year post-stroke was found to independently predict poor MCS scores at five years post-stroke. This finding underscores the importance of addressing depression in stroke survivors to improve long-term QoL. Additionally, factors such as old age, high NIHSS scores at admission, stroke recurrence, and disability were associated with poor PCS scores, indicating that both physical and mental health dimensions of QoL are influenced by various stroke-related factors.
The study also revealed that 10% of stroke survivors exhibited persistent depression at the one-year follow-up, consistent with previous research. This persistent depression was associated with lower MCS scores, emphasizing the need for targeted interventions to manage depression in stroke patients. The adverse effects of persistent depression on mental health dimensions of QoL remained significant even after adjusting for relevant covariates, suggesting that depression has a lasting impact on stroke survivors’ well-being.
Limitations
Several limitations should be considered when interpreting the results of this study. First, patients with severe aphasia were excluded due to the inability to complete self-rating scales, which may have introduced selection bias. Second, mood was only continuously assessed during the first year, and no data on mood changes between the one-year and five-year follow-ups were collected. Third, while baseline characteristics of included patients and those lost to follow-up were compared, no comparison was made between patients lost at the one-year follow-up and those included in the study.
Conclusion
This longitudinal study demonstrates that persistent depression at one year post-stroke is a significant predictor of poor mental health-related QoL at five years post-stroke. Other factors, such as old age, high NIHSS scores at admission, stroke recurrence, and disability, were associated with poor physical health-related QoL. These findings highlight the need for interventional strategies targeting persistent depression in stroke survivors to improve long-term QoL. Addressing both mental and physical health dimensions of QoL is essential for optimizing outcomes in stroke patients.
doi.org/10.1097/CM9.0000000000000400
Was this helpful?
0 / 0