title: Poststroke depression and its multifactorial nature: results from a prospective longitudinal study.
abstract: OBJECTIVE
  Poststroke depression (PSD) is commonly observed in stroke patients and has a negative impact on functional outcome and quality of life. Therefore, a prospective, longitudinal epidemiological study was conducted aiming to determine prevalence and risk factors for PSD at 1, 3, 6, 12 and 18 months poststroke.
  
  
  METHODS
  A total of 222 patients were included in the study and 201 patients entered data analysis. Demographic data, vascular risk factors, stroke characteristics, functional and neurocognitive outcome measures and psychosocial factors were considered as potential risk factors for PSD. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale (MADRS).
  
  
  RESULTS
  PSD was present at 1, 3, 6, 12 and 18 months poststroke in 24.5%, 27.1%, 28.3%, 19.8% and 26.3% of the patients respectively. Univariate regression analyses revealed that PSD was significantly associated with stroke severity, physical disability, cognitive impairment and stroke outcome during the 18 months time frame of the study. Reduced social activities and the presence of apraxia were consistently associated with PSD whereas aphasia was only significantly associated in the first 6 months after stroke. Patients with relational problems had a 3 times greater risk of becoming depressed at 18 months poststroke than patients without relational problems (OR=3.09; 95% CI=1.31-7.26).
  
  
  CONCLUSIONS
  Risk factors for PSD seem variable indicating the need for clinicians to consider the dynamic and multifactorial nature of PSD emphasizing the importance of a rigorous and long-term monitoring and support of stroke patients and their caregivers.
authors.affiliation: Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium. Electronic address: annemieke.deryck@student.uantwerpen.be.
authors.forename: A
authors.initials: A
authors.lastname: De Ryck
authors.affiliation: StatUa Center for Statistics, University of Antwerp, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Fransen
authors.affiliation: Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussel, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Brouns
authors.affiliation: Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Geurden
authors.affiliation: Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Peij
authors.affiliation: Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Department of Neurolinguistics, Vrije Universiteit Brussel, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Mariën
authors.affiliation: Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Department of Health Care Sciences, Artesis University College of Antwerp, Antwerp, Belgium; University of Groningen, University Medical Center Groningen, Department of Neurology and Alzheimer Research Center, Netherlands; Reference Centre for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
authors.forename: P P
authors.initials: PP
authors.lastname: De Deyn
authors.affiliation: Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Reference Centre for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Engelborghs
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000209:etiology / Q000523:psychology; D001072:Apraxias / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D066107:Social Skills; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D013997:Time Factors
keywords: Depression; Multifactorial; Poststroke depression; Prevalence; Risk factors; Stroke