Trajectory of Depressive Symptoms in a Longitudinal Stroke Cohort

Objectives: Knowledge of the trajectory of post-stroke depression is important to identify high-risk patients, develop precise management programs and enhance prognosis. We aimed to characterise the course of depressive symptoms within the first year post-stroke and to evaluate associations with time.

Materials and methods: Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) within the first week, and at 3- and 12-months post-stroke. Scores were dichotomised into symptoms 'present' (MADRS ≥ 7) or 'absent' (MADRS < 7). The course of depressive symptoms within individuals was mapped and categorised using a trajectory diagram. The association between time and the presence of depressive symptoms was investigated using random effects logistic regression. Logistic regression was also used to assess the likelihood of participants having depressive symptoms later, given their status at earlier time points.

Results: Of 142 ischaemic stroke survivors included for analysis, almost half (47.9%) experienced a change in depressive symptom status over time. Depressive symptoms were common at each timepoint (35-43%), although an association between time and frequency of depressive symptoms was not evident. Stroke survivors with depressive symptoms at 3 months were more likely to have depressive symptoms at 12 months, compared to those without symptoms at 3 months.

Conclusion: Our findings provide evidence for a dynamic trajectory of depressive symptoms in individuals in the first year post-stroke. The importance of repeated screening for depression is highlighted, though most necessary at 3 months post-stroke.