title: Key Factors Associated with Major Depression in a National Sample of Stroke Survivors.
abstract: BACKGROUND
  Depression, one of the most common complications encountered after stroke, is associated with poorer outcomes. The aim of this study was to determine the factors independently associated with and predictive of poststroke depression (PSD).
  
  
  METHODS
  We assessed the prevalence of depression (Patient Health Questionnaire [PHQ-8] score >10) among a national sample of adults (≥20 years) with stroke who participated in the National Health and Nutrition Examination Surveys from 2005 to 2010. Logistic regression and random forest models were used to determine the factors associated with and predictive of PSD, after adjusting for sociodemographic and clinical factors.
  
  
  RESULTS
  Of the 17,132 individuals surveyed, 546 stroke survivors were screened for depression, and 17% had depression, corresponding to 872,237 stroke survivors with depression in the United States. In the logistic regression model, after adjustment for sociodemographic variables, poverty (poverty index <200% versus ≥200%, odds ratio [OR] 2.61, 95% confidence interval [CI] 1.23-5.53) and 3 or more medical comorbidities (OR 1.59, 95% CI 1.01-2.49) were associated with higher odds of PSD; increasing age was associated with lower odds of PSD (per year OR .95, 95% CI .94-.97). In the random forest model, the 10 most important factors predictive of PSD were younger age, lower education level, higher body mass index, black race, poverty, smoking, female sex, single marital status, lack of cancer history, and previous myocardial infarction (specificity = 70%, sensitivity = 64%).
  
  
  CONCLUSIONS
  Although numerous factors were predictive of developing PSD, younger age, poverty, and multiple comorbidities were strong and independent factors. More aggressive screening for depression in these individuals may be warranted.
authors.affiliation: University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hirata
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Department of Biomathematics, University of California, Los Angeles, California.
authors.forename: Daniela
authors.initials: D
authors.lastname: Markovic
authors.affiliation: Department of Neurology, University of Southern California, Los Angeles, California; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California. Electronic address: towfighi@usc.edu.
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D016017:Odds Ratio; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Depression; NHANES; factors; poststroke depression; stroke