Post-stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke.
OBJECTIVE
To investigate the influence of depression on functional recovery after stroke.


METHODS
Multicentre cohort study of 85 patients admitted for clinical rehabilitation. A two-stage case-finding procedure was used to identify patients with depression. For the control group, consecutive nondepressed stroke patients were enrolled. Patients were interviewed at 3-6 weeks and six months after stroke onset.


METHODS
Three rehabilitation centres in the vicinity of Amsterdam.


METHODS
Functional outcome was determined by the Functional Independence Measure (FIM) and the Rehabilitation Activities Profile (RAP).


RESULTS
The prevalence of depression (35%) was comparable with the findings of earlier studies in other settings. Patients classified as depressed according to DSM III R criteria (American Psychiatric Association Diagnostic and statistical manual of mental disorders) had a significantly lower functional score, both at onset and after follow-up (FIM and RAP). There was, however, no significant difference in functional improvement between the depressed and the nondepressed group. Mean functional improvement in the six patients treated with antidepressants was 30% better than in the untreated (depressed) patients; numbers were too small for the results to attain statistical significance. Subset analysis showed a significantly higher outcome for nondepressed patients for the FIM subitems personal care and transfers. However, functional improvement was not significantly different for any of the subitems in depressed versus nondepressed patients.


CONCLUSIONS
Stroke patients with depression have significantly lower functional scores both at onset and after six months. Our results suggest under-recognition of post-stroke depression and a possible beneficial effect of antidepressant medication in depressed stroke patients. Further studies are required to determine the effect of antidepressants.
Rehabilitation Centre, Amsterdam, The Netherlands.
F B
FB
van de Weg
D J
DJ
Kuik
G J
GJ
Lankhorst
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D026741:Physical Therapy Modalities / Q000379:methods* / Q000523:psychology; D015995:Prevalence; D017678:Sex Distribution; D016896:Treatment Outcome