title: Explanatory factors for the association between depression and long-term physical disability after stroke.
abstract: OBJECTIVE
  To identify explanatory factors for the association between depression at 3 months after stroke and physical disability at 3 years.
  
  
  METHODS
  Data from the South London Stroke Register (1998-2013) were used. Patients (n = 3,612) were assessed at stroke onset. Follow-up at 3 months included assessment for depression with the Hospital Anxiety and Depression scale (scores ≥ 7 = depression), physical disability (Barthel index) cognitive function, smoking habit, selective serotonin reuptake inhibitors (SSRIs) use, perception of recovery and social support. Physical disability was reassessed at 3 years. The associations between depression at 3 months and physical disability at 3 years were estimated with multinomial regression adjusting for age, gender, ethnicity, stroke severity and possible explanatory factors for the association (introduced in the models first individually and then sequentially): pre-stroke medical history and physical disability, cognitive function, smoking, SSRIs, perception of recovery and social support at 3 months.
  
  
  RESULTS
  One thousand three hundred and seven survivors were assessed at 3 months, of which 418 (32.0%) had depression. Survivors with depression had a higher physical disability rate at 3 years. These associations remained significant after adjustment for individual explanatory factors but were not significant after adjustment for combined explanatory factors. Physical disability at 3 months was a relevant explanatory factor for this association. SSRIs were associated with severe, relative risk: 6.62 (2.92-15.02) P < 0.001, and moderate physical disability, relative risk: 3.45 (1.58-7.52) P = 0.002, at 3 years.
  
  
  CONCLUSIONS
  The association between depression and physical disability appears to be multifactorial. The use of SSRIs after stroke requires further research.
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Blizard Institute, Centre for Primary Care and Public Health, London E12AB, UK.
authors.forename: Luis
authors.initials: L
authors.lastname: Ayerbe
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Salma A
authors.initials: SA
authors.lastname: Ayis
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crichton
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK Stroke Unit, St. Thomas' Hospital, London SE17EH, UK.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Rudd
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK Guy's and St. Thomas' NHS Foundation Trust, National Institute for Health Research (NIHR) Biomedical Research Centre, London, UK.
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
mesh_terms: D000368:Aged; D003863:Depression / Q000150:complications*; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000523:psychology; D013997:Time Factors
keywords: antidepressive agents; cohort studies; depression; disability; older people; stroke