title: Major Depression as a Predictor of Poor Long-Term Survival in a Brazilian Stroke Cohort (Study of Stroke Mortality and Morbidity in Adults) EMMA study.
abstract: BACKGROUND
  The influence of poststroke depression on long-term survival is poorly investigated. Thus, we aimed to evaluate the influence of major depression disorder (MDD) on long-term survival in the participants from The Study of Stroke Mortality and Morbidity in Adults (EMMA Study) in São Paulo, Brazil.
  
  
  METHODS
  We prospectively evaluated ischemic and hemorrhagic stroke (HS) cases from the EMMA Study. Baseline and stroke characteristics and cardiovascular risk factors were evaluated according to MDD assessed by the Patient Health Questionnaire, which was applied 30 days after index event and periodically during 1-year follow-up. We performed Kaplan-Meier survival analysis, as well as crude and multiple Cox proportional hazards models.
  
  
  RESULTS
  In this subset of the EMMA Study, we evaluated 164 (85.9%) patients with ischemic stroke and 27 (14.1%) with HS. Among these, overall incidence of MDD was 25.1% during 1 year of follow-up, regardless stroke subtype. The peak rate of major depression postacute event was beyond 1 month. We observed a lower survival rate among individuals who developed poststroke MDD than among those who did not develop this condition after 1 year of follow-up (85.4% versus 96.5%, log rank P = .006). After multiple analysis, we kept a higher risk of all-cause mortality among those who developed MDD compared to participants without MDD (hazard ratio = 4.60, 95% confidence interval = 1.36-15.55, P = .01).
  
  
  CONCLUSIONS
  Our findings suggest that incident MDD is a potential marker of poor prognosis 1 year after stroke.
authors.affiliation: Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil. Electronic address: robertamello@hu.usp.br.
authors.forename: Roberta Ferreira
authors.initials: RF
authors.lastname: de Mello
authors.affiliation: Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Itamar de Souza
authors.initials: Ide S
authors.lastname: Santos
authors.affiliation: Institute of Mathematics and Statistics, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Airlane Pereira
authors.initials: AP
authors.lastname: Alencar
authors.affiliation: Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Isabela Martins
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Paulo Andrade
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Alessandra Carvalho
authors.initials: AC
authors.lastname: Goulart
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis
keywords: Stroke; cohort; depression; epidemiology; mortality; survival