Stroke: older age and prognostic score increased the risk of patient depression.

Clinical bottom line (level 2b)

  1. Nearly half of patients with stroke had depression at 12 months.
  2. Patients with stroke were at a decreased risk of depression at 3 months if they were in an active rehabilitation program.
  3. Patients with stroke were at an increased risk of depression at 3 months if they were older than 70 years or had a Scandinavian Stroke Scale prognostic score of 14 or less.
  4. 40% of carers of patients with stroke had depression at 12 months.
  5. Carers of patients with stroke were at an increased risk of depression at 3 months if their patients had a Rankin scale grade of III-IV at 3 months.
Kotila et al: Stroke 1998; 29: 368-372
Expires June 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: population-based, four districts in Finland

321 patients (aged mean 69 years, 51% male) first-ever stroke

Excluded if
  • <15 years old



    • Factors studied:
  • patient and caregiver depression
  • active rehabilitation program
  • age >70 years
  • Scandinavian Stroke Scale prognostic score = 14 points
  • Rankin scale grade of the patients at 3 months, III-V




    • Multivariate analysis was used to adjust for confounding factors.

    100% followed for 12 months
    Outcomes studied:
  • patient depression 10 or more on the Beck Depression Index
  • caregiver depression

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    patient depression 12 months 147/311 47.3%
    (41.7% to 52.8%)
    caregiver depression 12 months 74/184 40.2%
    (33.1% to 47.3%)

    prognostic factor for
    patient depression     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    active rehabilitation program 12 months 71/128
    (55.5%)     		0.55
    (0.34 to 0.88)     		-7
    (-31 to -4)
    age >70 years ? 1.64
    (1.02 to 2.62)
    Scandinavian Stroke Scale prognostic score = 14 points ? 2.15
    (1.19 to 3.88)

    prognostic factor for
    caregiver depression     		time to outcome control rate (%) adjusted OR
    (95% CI)
    Rankin scale grade of the patients at 3 months, III-V ? 2.06
    (1.09 to 3.90)

    Comments

    1. Two of the districts involved had active rehabilitation programs after discharge, together with support and social activities provided by the local divisions of the FHA, and the other two had no such program.
    2. Not enough data was given to calculate NNF+s.

    Citation

    1. Kotila M, Numminen H, Waltimo O, et al: Depression after stroke: Results of the FINNSTROKE study. Stroke 1998; 29: 368-372
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome depression