Comparison of two depression measures for predicting stroke outcomes.
OBJECTIVE
Little is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ability to predict quality of life and functioning at 3 and 12 months after stroke.


METHODS
A cohort of 460 ischemic stroke patients from the 2005 Greater Cincinnati/North Kentucky Stroke Study was assessed within 2 weeks of the stroke, including the 10-item Center for Epidemiological Studies Depression Scale (CESD) for current symptoms of depression. Lifetime history of depression was also assessed by a 2-question measure at 3 and 12 months after stroke. Two outcome measures, Stroke Specific Quality of Life (SSQOL) and the modified Rankin Scale (mRS) to assess functional status, were also collected at 3 and 12 months.


RESULTS
Of the 322 survivors included in the analysis, 52.2% reported depression on at least one measure. Both current symptoms and lifetime history of depression predicted poor functional outcomes and poor quality of life at 3 and 12 months, after adjustment for age, race, sex, prior stroke, baseline functional status, and stroke severity. The combination of depression measures was a better predictor of poor outcomes than either measure alone.


CONCLUSIONS
Depression by either measure was a frequent, substantial, and independent predictor of poor outcomes at 3 and 12 months after stroke. Stroke outcomes studies should further examine the predictive value of assessing both depressive symptoms at the time of the stroke and lifetime history of depression.
University of Cincinnati, Department of Psychiatry, Cincinnati, OH 45267-0559, United States. Lawson.wulsin@uc.edu
Lawson
L
Wulsin
Kathleen
K
Alwell
Charles J
CJ
Moomaw
Christopher J
CJ
Lindsell
Dawn O
DO
Kleindorfer
Daniel
D
Woo
Matthew L
ML
Flaherty
Pooja
P
Khatri
Opeolu
O
Adeoye
Simona
S
Ferioli
Joseph P
JP
Broderick
Brett M
BM
Kissela
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D011336:Probability; D011581:Psychological Tests / Q000592:standards; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D018434:Sickness Impact Profile; D020521:Stroke / Q000150:complications / Q000523:psychology; D013997:Time Factors