Depressed mood after intracerebral hemorrhage: the FAST trial.
OBJECTIVE
Depression is a frequent and important complication of stroke. Few data exist on the prevalence of depression/depressed mood after intracerebral hemorrhage (ICH) and the relationship between depression/depressed mood and the quality of life (QoL) more generally experienced by survivors of ICH.


METHODS
Factor Seven for Acute Hemorrhagic Stroke (FAST) was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. All patients were evaluated at day 90 after ICH onset for depressed mood and QoL with the Hamilton Depression Rating Scale (HDRS) and the EuroQoL, respectively. Multivariate stepwise logistic regression was used to develop a predictive model for depressed mood at day 90. Relationships between HDRS and EuroQoL scores at day 90 were evaluated with Spearman correlation coefficients.


RESULTS
657 patients were alive at 3 months after ICH onset; 596 (91%) completed the HDRS. Twenty percent reported an HDRS score >10, indicating at least a minor degree of depressed mood; 6% endorsed symptoms of severely depressed mood. Significant predictors of depressed mood included comorbidities (p = 0.0022), moderate to severe neurological impairment according to the National Institutes of Health Stroke Scale (NIHSS) at day 15 (p = 0.0097), physical disability as measured by the Barthel Index (BI) at day 15 (p = 0.0486), and female gender (p = 0.04), but not hemorrhage severity or a history of depression. Irrespective of the presence of post-ICH disability and impairment, the severity of depressed mood at day 90 was significantly correlated with poor QoL.


CONCLUSIONS
Depressed mood affects approximately 20% of ICH survivors and adversely affects QoL. Physicians should be vigilant to ensure that chronically ill and severely impaired survivors of ICH are adequately monitored and treated for depression after ICH.
Christensen
Michael C
MC
Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark. mcrc@novonordisk.com
Mayer
Stephan A
SA
Ferran
Jean-Marc
JM
Kissela
Brett
B
D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D003863:Depression / Q000209:etiology* / Q000523:psychology*; D004185:Disability Evaluation; D004311:Double-Blind Method; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011581:Psychological Tests; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index
D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa