title: The correlates and course of depression in patients with lacunar stroke: results from the Secondary Prevention of Small Subcortical Strokes (SPS3) study.
abstract: BACKGROUND
  Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability.
  
  
  METHODS
  Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject.
  
  
  RESULTS
  The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96-0.99), male gender (OR 0.62; 95% CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3-2.4), living with a spouse/family (OR 1.6; 95% CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06-1.17) for each 1-year increase in time.
  
  
  CONCLUSIONS
  One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.
authors.affiliation: School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA. whitec2@uthscsa.edu
authors.forename: Carole L
authors.initials: CL
authors.lastname: White
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Wallace
authors.forename: Janet
authors.initials: J
authors.lastname: Braimah
authors.forename: Alice
authors.initials: A
authors.lastname: Liskay
authors.forename: Ana
authors.initials: A
authors.lastname: Roldan
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D004185:Disability Evaluation; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D059409:Stroke, Lacunar / Q000150:complications* / Q000523:psychology*