title: Depression among stroke survivors: a community-based, prospective study from Kolkata, India.
abstract: OBJECTIVE
  Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community.
  
  
  METHODS
  From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case-control study was undertaken to determine the odds of depression in SS.
  
  
  RESULTS
  Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%-42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90-3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09-39.47).
  
  
  CONCLUSIONS
  Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.
authors.affiliation: Department of Psychiatry, Institute of Psychiatry, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, India.
authors.forename: Neelanjana
authors.initials: N
authors.lastname: Paul
authors.forename: Sujata
authors.initials: S
authors.lastname: Das
authors.forename: Avijit
authors.initials: A
authors.lastname: Hazra
authors.forename: Malay Kumar
authors.initials: MK
authors.lastname: Ghosal
authors.forename: Biman Kanti
authors.initials: BK
authors.lastname: Ray
authors.forename: Tapas Kumar
authors.initials: TK
authors.lastname: Banerjee
authors.forename: Arijit
authors.initials: A
authors.lastname: Chaudhuri
authors.forename: Debasish
authors.initials: D
authors.lastname: Sanyal
authors.forename: Arindam
authors.initials: A
authors.lastname: Basu
authors.forename: Shyamal Kumar
authors.initials: SK
authors.lastname: Das
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D003906:Developing Countries; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000523:psychology*; D017741:Survivors / Q000523:psychology*
keywords: India; Stroke; community; depression; mortality; prospective