title: The natural history of depression and trajectories of symptoms long term after stroke: The prospective south London stroke register.
abstract: BACKGROUND
  The natural history of depression in stroke patients is complex and the mechanism of change in symptoms over time is not fully understood. We hypothesise that there are different trajectories of symptoms after stroke.
  
  
  METHODS
  The primary analysis comprised 761 patients who completed 5 years follow up, obtained from the prospective South London Stroke Register (1998-2013). The Hospital Anxiety and Depression scale (HADs) was used to screen patients for depression symptoms at 3 months after stroke, then annually. Trajectories of depression symptoms were detected using group based trajectory modelling (GBTM).
  
  
  RESULTS
  Four patterns of symptoms (Groups I-IV) were identified: 6.31% of patients had severe symptoms, improved slightly in early years then worsen (predicted mean HADs score, 15.74 (se=1.06)); 28.65% had moderate symptoms, a tendency to get worse over time, predicted mean score 7.36 (se=0.35); 49.54% had mild symptoms and a tendency of getting worse, predicted mean 3.89 (se=0.30), and 15.51% of the cohort, had no symptoms and remained so over time. The lowest rate of Selective serotonin reuptake inhibitors (SSRI) use, over 5 years after stroke was 1.1% for group (I) and highest was 35% for group (IV). Sensitivity analyses were used to assess the robustness of the findings using several inclusion criteria and findings agreed with the primary results.
  
  
  CONCLUSIONS
  There is loss to follow up of around 20%.
  
  
  CONCLUSIONS
  The study identified 4 trajectories of depression symptoms, providing useful information for the long term management of stroke patients and for the implementation of cost effective personalized interventions.
authors.affiliation: Division of Health and Social Care Research King's College London, London, UK. Electronic address: salma.ayis@kcl.ac.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; Blizard Institute. Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 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: Siobhan L
authors.initials: SL
authors.lastname: Crichton
authors.affiliation: Division of Health and Social Care Research King's College London, London, UK; Stroke Unit, Guy's and St. Thomas' NS Foundation Trust, St. Thomas' Hospital, London, 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; National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London at King's College Hospital NHS Foundation Trust, UK.
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D020521:Stroke / Q000523:psychology*; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Depression symptoms; Group based trajectory modelling (GBTM); Natural history of depression; Stroke