Stroke survivors at increased risk for depression vs. those
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Stroke survivors experienced a substantially increased risk for subsequent depression compared with those who had a myocardial infarction, according to results of a retrospective cohort study published in Neurology.

Researchers sought to comprehensively evaluate predictors of PSD in the US and compare PSD to post-myocardial infarction (MI) depression, in order to determine whether ischemic stroke (IS) uniquely elevates risk of depression.

This is a retrospective cohort study of 100% de-identified inpatient, outpatient, and subacute nursing Medicare data for US patients aged greater than 65 years. It calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years following index admission. Researchers performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years post-stroke vs. MI, and independent predictors of PSD, and controlled for patient demographics, comorbidities, length of stay and acute stroke interventions.

Results:
-- In fully adjusted models, stroke patients (n=174,901) were nearly 50% more likely than MI patients (n=193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596±0.001 in stroke patients versus 0.0973±0.000778 in MI patients).

-- History of anxiety was the strongest predictor of PSD, while discharge home was most protective.

-- Female patients, White patients, and patients younger than 75 years were more likely to be diagnosed with depression post-stroke.

Conclusively, despite the similarities between MI and stroke, patients who suffer from stroke were significantly more likely to develop depression. There were several predictors of post-stroke depression, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all stroke patients.

Source: https://n.neurology.org/content/early/2021/03/15/WNL.0000000000011828
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